A Novel Fluorescence-Triggered Auditory Feedback Photosensor for Precision Lymph Node Mapping.

Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials

PEARLS: Is Our Use of Prostate-specific Membrane Antigen Positron Emission Tomography-Computed Tomography Meaningful for Our Patients?

Low local recurrence rate without postmastectomy radiation in node-negative breast cancer patients with tumors 5 cm and larger

Lymphatic imaging is an important step for the identification of lymphonodal positive disease in solid malignancies. Various methods have been established to detect positive lymph nodes, but the available diagnostic tools leave some inherent drawbacks. The aim of this study was to validate the indocyanine green (ICG) guided approach for transcutaneous and transmesenterial navigation with accurate lymph vessel and node identification for regional lymph node staging in solid malignancies. After institutional review board approval, a planar fluorescence imaging system was applied for lymphography and lymph node detection using ICG. A total of 96 patients were recruited and subject to fluorescence navigation for axillary (n = 46), inguinal (n = 16), and mesenterial (n = 34) visualization to analyze technical and clinical feasibility of the method after regional lymph node dissection and the applicability. Overall fluorescence imaging identified lymphatic vessels and the SLN in 92 out of 96 patients (detection rate: 96%) after a mean injection of 7 mg ICG. Sensitivity based on fluorescent emission of ICG navigation was 95.6% in 65 out of 68 patients with lymph node dissection. All solid tumors were feasible for fluorescence-guided navigation with a broad spectrum. Fluorescence-guided real-time lymphography with navigation to regional lymph nodes enables accurate visualization for a broad spectrum of different solid tumors with potential lymphonodal spread. In addition, the technique can be applied for lymphography in non-malignant diseases. With reference to the broad application spectrum, institutional investment in camera equipment can be justified.

Dendritic cells (DCs) are potent antigen-presenting cells that are central to the regulation, maturation, and maintenance of the cellular immune response against cancer. In contrast, CD4(+)CD25(+) regulatory T cells (Tregs) play a central role in self-tolerance and suppress antitumor immunity. In this study, we investigated the clinical significance of mature CD83(+) DCs and Foxp3(+) Tregs in the primary tumor and regional lymph nodes from the viewpoint of the two opposing players in the immune responses. We investigated, immunohistochemically, the density of CD83(+) DCs and Foxp3(+) Tregs in primary lesions of gastric cancer (n=123), as well as in regional lymph nodes with (n=40) or without metastasis (n=40). Decreased density of CD83(+) DCs and increased density of Foxp3(+) Tregs were observed in the primary tumor and metastatic lymph nodes. Density was significantly correlated with certain clinicopathological features. Poor prognosis was observed in patients with a low density of CD83(+) DCs and a high density of Foxp3(+) Tregs in primary lesions. For patients with metastatic lymph nodes, the density of CD83(+) DCs in negative lymph nodes was found to be an independent prognostic factor by multivariate analysis. The density of CD83(+) DCs and Foxp3(+) Tregs was inversely correlated with tumor progression and reflected the prognosis of gastric cancer.

We investigated the delivery of adriamycin (ADR) to the regional lymph nodes of the stomach following the gastric submucosal injection of liposomal adriamycin (Lipo‐ADR) in 34 gastric carcinoma patients, as well as following intravenous administration of free ADR (F‐ADR) in another 18 patients. Prior to radical gastrectomy, Lipo‐ADR was endoscopically injected into the gastric submucosa adjacent to the primary tumor via a needle‐tipped catheter. After Lipo‐ADR injection, the ADR concentration in the primary and secondary drainage lymph nodes was higher than in the other regional lymph nodes. Thus, the regional nodes more susceptible to metastasis showed higher levels of ADR. In contrast, the intravenous administration of F‐ADR produced a similar and far lower ADR concentration in all the nodes. Delivery of ADR to the primary drainage lymph nodes following injection of 5 ml of Lipo‐ADR was compared with delivery to the left gastric artery lymph nodes after intravenous administration of an equal dose of F‐ADR. The ADR levels (μg/g) after gastric submucosal injection were 15.1±8.30 on day 1 (n = 4); and 11.9±4.80 on day 4 (n = 6). Those after intravenous administration were 0.29±0.10 on day 1 (n = 4); and 0.36±0.0 on day 4 (n = 2). The differences between the two groups were significant (P<0.05). The ADR levels after the gastric submucosal injection were far higher than those after intravenous administration. These findings indicate that the gastric submucosal injection of Lipo‐ADR can specifically deliver ADR to the regional lymph nodes at high concentrations. Such preoperative adjuvant chemotherapy targeting the regional lymph nodes may be useful for preventing the lymph node recurrence of gastric carcinoma.

Simple SummaryApocrine gland anal sac adenocarcinoma (AGASACA) is a locally aggressive tumor with a high metastatic rate to the regional ileo-sacral lymph nodes and later to distant sites. Clinical signs depend on the tumor and regional lymph nodes size or on the paraneoplastic hypercalcemia. Therefore, dogs are often referred for perineal swelling, tenesmus, constipation and/or polyuria, polydipsia. Surgical excision of both the neoplastic anal sac and the metastatic regional lymph nodes represents the standard of care. Adjuvant chemotherapy and/or radiotherapy are also indicated. Prognostic factors include tumor size, hypercalcemia, regional lymph nodes metastasis and tumor histologic features. The aim of the study was to retrospectively evaluate the prognostic significance of tumor Ki67 expression. The authors’ hypothesis was that higher Ki67 index correlated with decreased disease-free interval and overall survival time. Clinical data such as tumor size, regional lymph nodes metastasis and hypercalcemia at presentation and histological features such as tumor pattern, mitotic count, necrosis, inflammatory infiltration, vascular invasion, anisokaryosis, and anisocytosis were also investigated and correlated to the oncologic outcome in the dogs included in the study.Apocrine gland anal sac adenocarcinoma (AGASACA) is locally aggressive and highly metastatic to regional lymph nodes. The aim of this study was to evaluate the prognostic significance of Ki67 in surgically excised AGASACA. Prognostic impact of size, regional lymph nodes metastasis, hypercalcemia, histologic pattern, mitotic count, necrosis, inflammatory and lympho-vascular invasion, anisokaryosis and anisocytosis was also evaluated. Thirty-five dogs were included, twenty-four of which also had metastatic lymph nodes. When the entire population was evaluated, only metastatic disease spread to regional lymph nodes, and necrosis and inflammatory infiltration were correlated to prognosis. When only dogs with metastatic disease were evaluated, size, solid histologic pattern, presence of lymphatic and vascular invasion showed influence on prognosis. Ki67 index was not associated with survival time and disease free interval in any case. The results of this study showed that lymph nodes metastasis at diagnosis reduced disease free interval. Moreover, tumor size greater than 5.25 cm, presence of lymphatic and vascular invasion and a solid histologic pattern were associated with a shorter survival time in dogs with metastasis to regional lymph nodes. Ki67 expression was not significantly associated with prognosis, therefore it could not be considered as a prognostic factor in this tumor type, while the role of hypercalcemia remained unclear.

Lymph node (LN) metastasis has been associated with shorter survival times in dogs with mast cell tumour (MCT), and treatment of metastatic LN with lymphadenectomy or irradiation has been demonstrated to improve outcomes. Identification of metastatic LN in dogs with MCT is therefore of both prognostic and therapeutic significance. The aim of this prospective, exploratory study was to investigate whether fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) is a useful staging tool for the detection of metastatic LN in dogs with cutaneous or subcutaneous MCT, using histopathology as the gold standard. Sixteen client-owned dogs with cytologically or histologically confirmed cutaneous or subcutaneous MCTs underwent full-body 18F-FDG-PET/CT followed by surgical removal and histopathology of the primary tumour and regional LN(s). The maximum standard uptake value (SUVmax) of the tumour and LN(s) was measured. Primary tumours were graded using both the Patnaik and Kiupel grading systems, and mitotic count was tabulated. LNs were categorised based on Weishaar's histologic criteria for nodal metastasis. Eighteen primary tumours were excised: six subcutaneous and 12 cutaneous MCTs. Of 33 excised regional LNs, 18 (55%) were categorised as metastatic (≥ HN2). There was no difference between the median SUVmax of metastatic (3.88) and nonmetastatic LNs (3.16) (p = 0.41). SUVmax was positively correlated with the mitotic count of the primary tumour (p = 0.02). The results of this exploratory study suggest that 18F-FDG-PET/CT may not be useful for identifying metastatic LNs in canine MCT.

Diagnostic performance of somatostatin receptor positron emission tomography in preoperative evaluation of pancreatic neuroendocrine tumor lymph node metastases.

Artificial intelligence (AI) has demonstrated high accuracy in detecting lymph node (LN) metastases in treatment-naïve invasive breast cancer. However, its performance post-neoadjuvant chemotherapy (NACT) remains underexplored, where therapy-related morphologic alterations complicate assessment. To evaluate an AI algorithm (aetherAI) for detecting LN metastases in post-NACT invasive breast cancer. This retrospective study included 72 patients (58 [80.5%] post-NACT; 14 [19.5%] treatment-naïve), yielding 526 whole slide images and 1290 LNs. AI-generated LN contours were reviewed and modified, if needed. LN status was independently assessed by 4 pathologists and the AI algorithm. Discordant cases were resolved by consensus/immunohistochemistry to define ground truth, against which AI was compared. AI accurately contoured 1089 of 1290 LNs (84.4%). Pathologists showed 94.42% agreement, with 5.58% discordance. Against consensus ground truth, AI achieved 94.06% sensitivity, 90.14% specificity, 91.47% accuracy, and area under the curve (AUC) of 0.92. Performance was superior in treatment-naïve LNs (sensitivity, 98.95%; specificity, 98.08%; AUC, 0.99) compared with post-NACT LNs (sensitivity, 92.71%; specificity, 88.36%; AUC, 0.91) (P < .001). Within the post-NACT group, significantly reduced accuracy was associated with interobserver discordance (P < .001) and smaller metastases (micrometastasis, isolated tumor cells) (P < .001), but not noted in treatment-naïve cases. Most false results were attributable to therapy-induced changes. Unlike most prior studies restricted to treatment-naïve LNs, this post-NACT cohort demonstrates that NACT-related alterations reduce AI sensitivity and accuracy. Our findings suggest that incorporating post-NACT nodes into algorithm training will be essential for reliable clinical translation of AI-assisted LN evaluation.

Dynamic 18F-FDG Total Body PET Imaging as a Predictive Marker of Induction Chemo-Immunotherapy Followed by Concurrent Chemoradiotherapy Response in Locally Advanced Non-Small Cell Lung Cancer

Detection of metastasis of mediastinal lymph nodes in lung cancer patients with an artificial intelligence model.

Tumor Volume Changes Assessed With High Quality kVCT in Lung Cancer Patients Undergoing Concurrent Chemoradiation Therapy

Artificial Intelligence–Aided Diagnosis of Breast Cancer Lymph Node Metastasis on Histologic Slides in a Digital Workflow

ObjectiveRecent many studies have shown that whole body “diffusion-weighted imaging with background body signal suppression” (DWIBS) seems a beneficial tool having higher tumor detection sensitivity without ionizing radiation exposure for pediatric tumors. In this study, we evaluated the diagnostic performance of whole body DWIBS and 18F-FDG PET/CT for detecting lymph node and bone metastases in pediatric patients with neuroblastoma.MethodsSubjects in this retrospective study comprised 13 consecutive pediatric patients with neuroblastoma (7 males, 6 females; mean age, 2.9 ± 2.0 years old) who underwent both 18F-FDG PET/CT and whole-body DWIBS. All patients were diagnosed as neuroblastoma on the basis of pathological findings. Eight regions of lymph nodes and 17 segments of skeletons in all patients were evaluated. The images of 123I-MIBG scintigraphy/SPECT-CT, bone scintigraphy/SPECT, and CT were used to confirm the presence of lymph node and bone metastases. Two radiologists trained in nuclear medicine evaluated independently the uptake of lesions in 18F-FDG PET/CT and the signal-intensity of lesions in whole-body DWIBS visually. Interobserver difference was overcome through discussion to reach a consensus. The sensitivities, specificities, and overall accuracies of 18F-FDG PET/CT and whole-body DWIBS were compared using McNemer’s test. Positive predictive values (PPVs) and negative predictive values (NPVs) of both modalities were compared using Fisher’s exact test.ResultsThe total numbers of lymph node regions and bone segments which were confirmed to have metastasis in the total 13 patients were 19 and 75, respectively. The sensitivity, specificity, overall accuracy, PPV, and NPV of 18F-FDG PET/CT for detecting lymph node metastasis from pediatric neuroblastoma were 100, 98.7, 98.9, 95.0, and 100%, respectively, and those for detecting bone metastasis were 90.7, 73.1, 80.3, 70.1, and 91.9%, respectively. In contrast, the sensitivity, specificity, overall accuracy, PPV, and NPV of whole-body DWIBS for detecting bone metastasis from pediatric neuroblastoma were 94.7, 24.0, 53.0, 46.4 and 86.7%, respectively, whereas those for detecting lymph node metastasis were 94.7, 85.3, 87.2, 62.1, and 98.5%, respectively. The low specificity, overall accuracy, and PPV of whole-body DWIBS for detecting bone metastasis were due to a high incidence of false-positive findings (82/108, 75.9%). The specificity, overall accuracy, and PPV of whole-body DWIBS for detecting lymph node metastasis were also significantly lower than those of 18F-FDG PET/CT for detecting lymph node metastasis, although the difference between these 2 modalities was less than that for detecting bone metastasis.ConclusionThe specificity, overall accuracy, and PPV of whole-body DWIBS are significantly lower than those of 18F-FDG PET/CT because of a high incidence of false-positive findings particularly for detecting bone metastasis, whereas whole-body DWIBS shows a similar level of sensitivities for detecting lymph node and bone metastases to those of 18F-FDG PET/CT. DWIBS should be carefully used for cancer staging in children because of its high incidence of false-positive findings in skeletons.