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Objectives: To investigate the feasibility and effectiveness of a deep learning (DL) super-resolution (SR) ultrasound image reconstruction model for predicting cervical lymph node status in patients with papillary thyroid carcinoma(PTC). Methods: In this retrospective study, researchers recruited 544 patients with PTC and randomly assigned them to training and test sets. SR ultrasound images were acquired using SR technology to improve image resolution, and artificial features and DL features were extracted from the original (OR) and SR images, respectively, to construct a ML, DL model. The best model was selected and aggregated with clinical parameters to construct the nomogram. The performance of the model is evaluated by ROC curves, calibration curves and decision curves. Results: In distinguishing the presence or absence of metastatic lymph nodes, the predictive performance of the SR_ResNet 101 and SR_SVM models based on SR outperformed those based on OR. In the test set, SR_SVM AUC was 0.878 (95% CI 0.8203–0.9358), accuracy 0.854, while OR_SVM AUC was 0.822 (95% CI 0.7500–0.8937), accuracy 0.665. SR_ResNet 101 AUC was 0.799 (95% CI 0.7175–0.8806), accuracy 0.793, and OR_ResNet101 AUC was 0.751 (95% CI 0.6620–0.8401), accuracy 0.713. Subsequently, Nomogram_A and Nomogram_B were constructed by integrating the SR_SVM model and SR_ResNet 101 model, respectively, with clinical parameters, while Nomogram_C was constructed solely based on clinical indicators. In the test set, Nomogram_A demonstrated the best performance with an AUC of 0.930 (95% CI 0.8913–0.9682) and accuracy was 0.829. Nomogram_B AUC 0.868 (95% CI 0.8102–0.9261) and accuracy was 0.829, while Nomogram_C AUC 0.880 (95% CI 0.8257–0.9349) and accuracy was 0.787. The DeLong test revealed that the diagnostic performance of Nomogram_A based on SR_SVM was significantly higher than that of Nomogram_B, Nomogram_C, and the level of Radiologist (P < 0.05). The calibration curves and Hosmer–Lemeshow tests confirmed a high degree of fit, and the decision curve analysis demonstrated clinical value and potential patient benefit. Conclusions: The predictive model constructed using SR reconstructed ultrasound images demonstrated superior performance in predicting preoperative cervical lymph node metastasis in PTC compared to OR images. The nomogram prediction model based on SR images has the potential to enhance the accuracy of predictive models and aid in clinical decision-making. [ABSTRACT FROM AUTHOR]

Abstract Objectives To investigate the feasibility and effectiveness of a deep learning (DL) super-resolution (SR) ultrasound image reconstruction model for predicting cervical lymph node status in patients with papillary thyroid carcinoma(PTC). Methods In this retrospective study, researchers recruited 544 patients with PTC and randomly assigned them to training and test sets. SR ultrasound images were acquired using SR technology to improve image resolution, and artificial features and DL features were extracted from the original (OR) and SR images, respectively, to construct a ML, DL model. The best model was selected and aggregated with clinical parameters to construct the nomogram. The performance of the model is evaluated by ROC curves, calibration curves and decision curves. Results In distinguishing the presence or absence of metastatic lymph nodes, the predictive performance of the SR_ResNet 101 and SR_SVM models based on SR outperformed those based on OR. In the test set, SR_SVM AUC was 0.878 (95% CI 0.8203–0.9358), accuracy 0.854, while OR_SVM AUC was 0.822 (95% CI 0.7500–0.8937), accuracy 0.665. SR_ResNet 101 AUC was 0.799 (95% CI 0.7175–0.8806), accuracy 0.793, and OR_ResNet101 AUC was 0.751 (95% CI 0.6620–0.8401), accuracy 0.713. Subsequently, Nomogram_A and Nomogram_B were constructed by integrating the SR_SVM model and SR_ResNet 101 model, respectively, with clinical parameters, while Nomogram_C was constructed solely based on clinical indicators. In the test set, Nomogram_A demonstrated the best performance with an AUC of 0.930 (95% CI 0.8913–0.9682) and accuracy was 0.829. Nomogram_B AUC 0.868 (95% CI 0.8102–0.9261) and accuracy was 0.829, while Nomogram_C AUC 0.880 (95% CI 0.8257–0.9349) and accuracy was 0.787. The DeLong test revealed that the diagnostic performance of Nomogram_A based on SR_SVM was significantly higher than that of Nomogram_B, Nomogram_C, and the level of Radiologist (P

Abstract Background Prostate cancer has been well known to have a high prevalence among middle-aged and older men, with high incidence of metastases to the bone—the main metastatic site. However, prostate cancer among those less than 50 years of age is extremely rare, and neck swelling is seldom the initial symptom. Case presentation We herein report case of a 47-year-old Japanese male with poorly differentiated prostate cancer that had been initially diagnosed as a cancer of unknown primary with multiple lymph node and bone metastases before reaching a definitive diagnosis. The patient has been started on endocrine therapy and is currently alive without progression. Discussion and conclusion When locating the primary lesion in men with cancer of unknown primary, it is important to consider the possibility of prostate cancer, confirm serum prostate-specific antigen levels, and perform local prostate evaluation.

Background: Prostate cancer has been well known to have a high prevalence among middle-aged and older men, with high incidence of metastases to the bone—the main metastatic site. However, prostate cancer among those less than 50 years of age is extremely rare, and neck swelling is seldom the initial symptom. Case presentation: We herein report case of a 47-year-old Japanese male with poorly differentiated prostate cancer that had been initially diagnosed as a cancer of unknown primary with multiple lymph node and bone metastases before reaching a definitive diagnosis. The patient has been started on endocrine therapy and is currently alive without progression. Discussion and conclusion: When locating the primary lesion in men with cancer of unknown primary, it is important to consider the possibility of prostate cancer, confirm serum prostate-specific antigen levels, and perform local prostate evaluation. [ABSTRACT FROM AUTHOR]

Medullary thyroid carcinoma (MTC) constitutes approximately 5–10% of all thyroid cancers. Although the tumor forms in the thyroid, it doesn't originate from thyroid cells, but from the C cells or parafollicular cells which produce and release a hormone called calcitonin (CT). Starting from the second half of the 1900s, MTC was progressively studied and defined. This study aims to analyze the history, clinical presentation and biological behavior of MTC, bio-humoral and instrumental diagnosis, molecular profiling, genetic screening, preoperative staging and instrumental procedures, indispensable in expert and dedicated hands, such as high-resolution ultrasonography, CT-scan, MRI and PET/TC. We examine recommended and controversial surgical indications and procedures, prophylactic early surgery and multiple endocrine neoplasia surgery. Also, we discuss pathological anatomy classification and targeted therapies. The role of serum CT is valued both as undisputed and constant preoperative diagnostic marker, obscuring cytology and as early postoperative marker that predicts disease persistence. With a complete preoperative study, unnecessary or useless, late and extended interventions can be reduced in favor of tailored surgery that also considers quality of life. Finally, great progress has been made in targeted therapy, with favorable impact on survival. [ABSTRACT FROM AUTHOR]

The aim of this study was to establish the cut-off value for the thyroglobulin (Tg) concentration in washout fluid from fine needle aspiration biopsy (FNA-Tg) in the detection of cervical lymph node metastases of differentiated thyroid cancer (DTC). We evaluated the validity and clinical utility of fine needle aspiration biopsy cytology (FNAB-C), FNA-Tg, and the combined method in detecting DTC recurrences. The study included 82 patients after the total thyroidectomy and elective and, in some cases, also selective cervical lymphadenectomy. The majority of patients also underwent subsequent 131I ablative therapy. The patients presented with 1–6 enlarged and/or ultrasonographically suspicious cervical lymph nodes. One to four aspirates of each lymph node were taken, with a total of 297 samples. An FNA-Tg of 4.34 ng/mL was established as the cut-off value for detecting cervical lymph node DTC metastases for the IRMA Brahms DYNO test, Tg-S. FNAB-C is highly specific (91–99%) but not sensitive enough (53–69%) to be used as a standalone method in the detection of cervical lymph node metastases. FNA-Tg is more sensitive (91%), but caution should be taken when selecting patients for surgery with an FNA-Tg higher than the established cut-off value but lower than the serum Tg concentration. To select patients for lymphadenectomy, we recommend using the combined method (FNAB-C and FNA-Tg) with a sensitivity of 96% and specificity of up to 97%. More than one sample should be taken with each fine needle aspiration biopsy (FNAB) to obtain a representative set of samples. [ABSTRACT FROM AUTHOR]

To determine the prevalence of skip metastases in Oral-squamous-cell-carcinoma (OSCC). This prospective observational study was carried out on 100-cases of biopsy proven OSCC who underwent surgical treatment for the primary tumor along with neck dissection (ND). Data regarding depth of invasion (DOI) by primary tumor, perineural-invasion, lymphovascular-invasion, presence of metastatic-lymph-node (level, size, number and extranodal-extension) were collected from histopathology reports and were analyzed. Out of 100-cases, 73-were-male and 27-were-female. Mean age was 49.5 ± 12.3 years (range 24–4 years). Common subsites of tumor were buccal-mucosa, tongue and lower-alveolus in 40, 37 and 14% respectively. Pathological staging of tumor were stage-I, stage-II, stage-III, stage-IVa and stage-IVb in 22, 14, 25, 22 and 15% cases respectively. Preoperative neck staging was cN0 in 50 necks (47.2%) and cN+ in 56 necks (52.8%). In 100-patients 106-NDs (unilateral-94 and bilateral-6) were performed. Type of NDs were Supraomohyoid, extended-Supraomohyoid and modified radical neck-dissection in 23,07and76 cases respectively. Prevalence of cervical lymph node metastases was 36% (pN + necks). Among 36pN + patients; 25 (69.4%) cases, 20 (55.5%) cases, 9 (25%) cases, 4 (11.1%) cases, 2 (5.5%) cases had metastases to level-I, II, III, IV and V respectively. Skip-metastases was present in four-cases {level-IIb:one-case (2.78%), level-III: two-cases (5.5%) and level-V:one-case (2.78%)}. No-skip-metastasis to level-IV was noticed. All-four-cases of skip-metastases were from advance cases of squamous-cell-carcinoma of tongue with DOI > 5 mm. Skip-metastases to levels IIb, IV and V are uncommon in cases of OSCC. Most of the metastasis in our study was noted to levels I, II and III in a predictable fashion. Thus, extensive ND can be avoided in patients to prevent complications and morbidities associated with the same. [ABSTRACT FROM AUTHOR]

The aim of this study was to establish the cut-off value for the thyroglobulin (Tg) concentration in washout fluid from fine needle aspiration biopsy (FNA-Tg) in the detection of cervical lymph node metastases of differentiated thyroid cancer (DTC). We evaluated the validity and clinical utility of fine needle aspiration biopsy cytology (FNAB-C), FNA-Tg, and the combined method in detecting DTC recurrences. The study included 82 patients after the total thyroidectomy and elective and, in some cases, also selective cervical lymphadenectomy. The majority of patients also underwent subsequent 131I ablative therapy. The patients presented with 1–6 enlarged and/or ultrasonographically suspicious cervical lymph nodes. One to four aspirates of each lymph node were taken, with a total of 297 samples. An FNA-Tg of 4.34 ng/mL was established as the cut-off value for detecting cervical lymph node DTC metastases for the IRMA Brahms DYNO test, Tg-S. FNAB-C is highly specific (91–99%) but not sensitive enough (53–69%) to be used as a standalone method in the detection of cervical lymph node metastases. FNA-Tg is more sensitive (91%), but caution should be taken when selecting patients for surgery with an FNA-Tg higher than the established cut-off value but lower than the serum Tg concentration. To select patients for lymphadenectomy, we recommend using the combined method (FNAB-C and FNA-Tg) with a sensitivity of 96% and specificity of up to 97%. More than one sample should be taken with each fine needle aspiration biopsy (FNAB) to obtain a representative set of samples.

The aim of this study was to investigate the factors related to large-volume central cervical lymph node metastasis (LNM) in papillary thyroid carcinoma. A retrospective study of 340 patients with 642 papillary thyroid carcinoma nodules who underwent thyroidectomy in Peking Union Medical College Hospital between 2011 and 2015 was conducted. These nodules were divided into two groups by the number of central cervical lymph node metastases: large-volume central cervical LNM(>5metastatic lymph nodes, n = 129) and no central cervical LNM (n = 211). We evaluated the correlations between gender, age, chronic lymphocytic thyroiditis, thyroid ultrasonographic features, and large-volume central cervical LNM. We found that younger age (=40 years) (OR = 3.796, 95% CI = 2.842, 5.070), male gender (OR = 4.005, 95% CI = 2.858, 5.61), and ultrasonographic features such as tumor macroaxis size (OR = 2.985, 95% CI = 1.581, 5.633), tumor located in the isthmus (OR = 7.578, 95% CI = 4.863, 11.810), ill-defined margin (OR = 3.008, 95% CI = 1.986, 4.556), microcalcification (OR = 2.155, 95% CI = 1.585, 2.929), and abnormal cervical lymph nodes (OR = 13.753, 95% CI = 9.278, 20.385) were independent risk factors for large-volume central cervical LNMin papillary thyroid carcinoma, while chronic lymphocytic thyroiditis (OR = 0.248, 95% CI = 0.172, 0.358) was a protective factor. Younger age (=40 years), male sex, and ultrasonographic features such as tumor macroaxis size, tumor located in the isthmus, ill-defined margin, microcalcification, and abnormal cervical lymph nodes were independent risk factors for largevolume central cervical LNM in papillary thyroid carcinoma, while chronic lymphocytic thyroiditis can be considered a protective factor. Our results provide a reference for adjusting clinical treatment approaches. [ABSTRACT FROM AUTHOR]

Introduction: Papillary thyroid microcarcinoma (PTMC) that metastasizes to bone, especially metastasizes to contralateral humerus with so large mass, is rarely reported before. Case report: We presented a 50-year-old female patient with a large painful mass in the right humerus for 5 years, presenting with swelling of the right shoulder with limited mobility. Positron emission tomography-computed tomography (PET/CT) showed a large mass in the right humerus, bilateral lung lesions, and enlarged lymph nodes in the right supraclavicular fossa. Right humerus lesion biopsy and immunohistochemical evaluations confirmed that the lesion originated from the thyroid tissue. Then, the thyroid ultrasonography showed a hypo-echoic solid nodule with an irregular taller-than-wide shape in the upper of left thyroid lobe and enlarged lymph nodes with the absence of fatty hilum in the contralateral right IV compartment. The total thyroidectomy and cervical lymph node dissection were undertaken; the histopathology confirmed the diagnosis of PTMC with contralateral cervical lymph node metastasis. Conclusion: We reported a case of PTMC with contralateral large humerus and cervical lymph node metastasis and demonstrated the PET/CT images of the metastatic large humerus and thyroid ultrasonographic appearances of the PTMC and enlarged cervical lymph node. [ABSTRACT FROM AUTHOR]

Background: This population-based study investigated the influence of different lymph node (LN) classifications on overall survival (OS) in head and neck cancer (HNC). Methods: 401 patients (median age: 57 years; 47% stage IV) of the Thuringian cancer registries with diagnosis of a primary HNC receiving a neck dissection (ND) in 2009 and 2010 were included. OS was assessed in relation to total number of LN removed, number of positive LN, LN ratio, and log odds of positive LN (LODDS). Results: Mean number of LODDS was 0–0.96 ± 0.57. When limiting the multivariate analysis to TNM stage, only the UICC staging (stage IV: HR 9.218; 95% CI 2.721–31.224; p < 0.001) and LODDS > – 1.0 (HR 2.120; 95% CI 1.129–3.982; p = 0.019) were independently associated with lower OS. Conclusion: LODDS was an independent and superior predictor for OS in HNC in a population-based setting with representative real-life data. [ABSTRACT FROM AUTHOR]

IntroductionFollicular thyroid carcinoma (FTC) rarely metastasizes to regional lymph nodes, as they mainly metastasize through hematogenous route; in particular, a large FTC with only lateral lymph node metastasis and without distant metastasis has rarely been reported.Case reportWe present a 66-year-old male patient with a progressively growing thyroid for more than 20 years, causing tracheal compression and narrowing. Neck ultrasonography, computed tomography (CT), magnetic resonance (MR) imaging and positron emission tomography–computed tomography (PET/CT) were carried out to obtain images of the thyroid and surrounding tissues. Total thyroidectomy and cervical lateral and central lymph node dissection were undertaken, and histopathological, and immunohistochemical evaluations and molecular pathology confirmed the diagnosis of FTC with multiple cervical lymph node metastases.ConclusionWe have reported a rare case of large FTC with diffuse nodal involvement but no distant metastases. We present the thyroid ultrasound, neck CT, MR and whole body PET/CT.

Abstract Background Patients with stage IV gastric cancer have a poor prognosis despite improvements in intensive treatment regimens, including chemotherapy. Recently, conversion surgery has received much attention as it can provide long-term survival in stage IV gastric cancer patients who are responsive to chemotherapy. Herein, we describe the case of a patient who underwent conversion surgery for metastatic gastric cancer that was performed over 2 years after an initial diagnosis of cancer of unknown primary (CUP) with metastasis of the cervical lymph nodes and the ovary. Case presentation A 67-year-old woman with cervical lymphadenopathy was referred to our hospital. Computed tomography showed left cervical lymphadenopathy and bilateral ovarian enlargement. Endoscopic survey revealed no signs of malignancy in the upper or the lower gastrointestinal tract. Pathological findings after cervical lymphadenectomy revealed a signet-ring cell carcinoma and were suggestive of gastric cancer metastases. However, multiple evaluations yielded no evidence of gastric cancer and the patient was diagnosed with CUP. She was prescribed chemotherapy for gastric cancer and underwent bilateral oophorectomy after undergoing chemotherapy for 18 months. Pathologic analysis of oophorectomy tissue revealed findings identical to those seen in the cervical lymph nodes. At about 2 years after the initial diagnosis, an esophagogastroduodenoscopy revealed evidence of gastric cancer. We performed a distal gastrectomy with D2 lymphadenectomy. Her postoperative course was uneventful and she remains alive with no signs of disease recurrence at 3 months post-surgery. Conclusions To the best of our knowledge, this is the first report describing successful conversion surgery for stage IV gastric cancer in a patient whose cancer was definitively diagnosed 2 years after an initial diagnosis of CUP.

Purpose: To compare predictive efficiency of multiple classifiers modeling and establish a combined magnetic resonance imaging (MRI) radiomics model for identifying lymph node (LN) metastases of papillary thyroid cancer (PTC) preoperatively. Materials and methods: A retrospective analysis based on the preoperative MRI scans of 109 PTC patients including 77 patients with LN metastases and 32 patients without metastases was conducted, and we divided enroll cases into trained group and validation group. Radiomics signatures were selected from fat-suppressed T2-weighted MRI images, and the optimal characteristics were confirmed by spearman correlation test, hypothesis testing and random forest methods, and then, eight predictive models were constructed by eight classifiers. The receiver operating characteristic (ROC) curves analysis were performed to demonstrate the effectiveness of the models. Results: The area under the curve (AUC) of ROC based on MRI texture diagnosed LN status by naked eye was 0.739 (sensitivity = 0.571, specificity = 0.906). Based on the 5 optimal signatures, the best AUC of MRI radiomics model by logistics regression classifier had a considerable prediction performance with AUCs 0.805 in trained group and 0.760 in validation group, respectively, and a combination of best radiomics model with visual diagnosis of MRI texture had a high AUC as 0.969 (sensitivity = 0.938, specificity = 1.000), suggesting combined model had a preferable diagnostic efficiency in evaluating LN metastases of PTC. Conclusion: Our combined radiomics model with visual diagnosis could be a potentially effective strategy to preoperatively predict LN metastases in PTC patients before clinical intervention. [ABSTRACT FROM AUTHOR]

Background: Patients with stage IV gastric cancer have a poor prognosis despite improvements in intensive treatment regimens, including chemotherapy. Recently, conversion surgery has received much attention as it can provide long-term survival in stage IV gastric cancer patients who are responsive to chemotherapy. Herein, we describe the case of a patient who underwent conversion surgery for metastatic gastric cancer that was performed over 2 years after an initial diagnosis of cancer of unknown primary (CUP) with metastasis of the cervical lymph nodes and the ovary. Case presentation: A 67-year-old woman with cervical lymphadenopathy was referred to our hospital. Computed tomography showed left cervical lymphadenopathy and bilateral ovarian enlargement. Endoscopic survey revealed no signs of malignancy in the upper or the lower gastrointestinal tract. Pathological findings after cervical lymphadenectomy revealed a signet-ring cell carcinoma and were suggestive of gastric cancer metastases. However, multiple evaluations yielded no evidence of gastric cancer and the patient was diagnosed with CUP. She was prescribed chemotherapy for gastric cancer and underwent bilateral oophorectomy after undergoing chemotherapy for 18 months. Pathologic analysis of oophorectomy tissue revealed findings identical to those seen in the cervical lymph nodes. At about 2 years after the initial diagnosis, an esophagogastroduodenoscopy revealed evidence of gastric cancer. We performed a distal gastrectomy with D2 lymphadenectomy. Her postoperative course was uneventful and she remains alive with no signs of disease recurrence at 3 months post-surgery. Conclusions: To the best of our knowledge, this is the first report describing successful conversion surgery for stage IV gastric cancer in a patient whose cancer was definitively diagnosed 2 years after an initial diagnosis of CUP. [ABSTRACT FROM AUTHOR]

Background: This systematic review and meta‐analysis aims to evaluate the effectiveness of palatine tonsillectomy in patients with cervical metastasis from squamous cell carcinoma of unknown primary (SCCUP) origin. Methods: A systematic review including studies that encompassed palatine tonsillectomy in the SSCUP diagnostic evaluation was conducted. A single arm meta‐analysis was then made to obtain the overall identification rate of tonsillectomy. Results: Fourteen studies were included, comprising 673 patients who underwent 416 palatine tonsillectomies, 338 preformed during examination under anesthesia (EUA) and 78 managed with transoral robotic surgery (TORS). A total of 140 occult tonsillar malignancies were identified; of these, 124 (89%) were ipsilateral, 2 (1%) contralateral, and 14 (10%) synchronous bilateral. Meta‐analysis of 11 studies showed an overall detection rate of tonsillectomy of 0.34 (99% confidence interval 0.23‐0.46). Conclusion: Palatine tonsillectomy is a valuable diagnostic tool in the management of patients with head and neck SCCUP. Bilaterality of tonsillectomy should be taken into consideration. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the performance of preoperative ultrasound in the diagnosis of cervical lymph nodes metastases (CLNM) of papillary thyroid cancer (PTC) and its value in assisting cervical lymph node dissection (CLND).Methods: PubMed, EMBASE and Cochrane Library databases were searched to identify relevant studies up to Sep. 2017. Overall sensitivity, specificity, and diagnostic odds ratio (DOR) were used to assess the diagnostic efficacy of ultrasound in detecting central and lateral CLNM of PTC.Results: Nineteen studies comprising 4014 patients were included in the meta-analysis. The pooled sensitivity, specificity, DOR and area under curve (AUC) of ultrasound in detecting central CLNM were 0.33 (95% confidence interval (95% CI): 0.31-0.35), 0.93 (95% CI: 0.92-0.94), 5.63 (95% CI: 3.50-9.04), and 0.69, respectively; and lateral CLNM were 0.70 (95% CI: 0.68-0.72), 0.84 (95% CI: 0.82-0.85), 18.7 (95% CI: 10.3-33.9) and 0.88, respectively. We found that the rate of central CLNM of PTC was 48.0%, and 36.2% of the dissected lymph nodes were metastatic, meanwhile, the rate of lateral CLNM of PTC was 59.2%, and 46.6% of the dissected lymph nodes were metastatic in the meta-analysis.Conclusions: Preoperative ultrasound demonstrates poor sensitivity in the diagnosis of central CLNM, and good diagnostic efficacy for lateral CLNM of PTC. Prophylactic central CLND is recommended to PTC patients due to the high incidence of central CLNM and low diagnostic efficacy of ultrasound. [ABSTRACT FROM AUTHOR]

Introduction: Amongst all the malignant tumours, laryngeal cancer is found in 2.2% of males and 0.4% of females. Histopathologically, 90-95% of all laryngeal cancer is Squamous Cell Carcinoma (SCC). Tumour stage and cervical lymph node metastases are the most influential factors in determining a worsening prognosis. Aim: To investigate the relationship between perineural invasion, peritumoural inflammation, other commonly used prognostic parameters such as tumour stage, and cervical lymph node metastases in laryngeal SCC which contribute to the follow-up and treatment of patients. Materials and Methods: The pathology archive at Istanbul Sisli Hamidiye Etfal Education and Research Hospital was utilised for this research. Retrospective analysis of data on 110 cases of laryngectomy and neck dissection specimens was performed. Cases diagnosed as SCC were included in the study. Histopathologic analysis was conducted on the paraffin-embedded tissue sections of 110 cases. The data were encoded, transmitted to a computer, and analysed using SPSS® 20.0. The Kruskal-Wallis H test was used to compare the groups. Statistical significance was considered to be p-value≤0.050. Results: The rate of cervical lymph node metastases was higher in the presence of perineural invasion, mild peritumoural inflammation, and advanced tumour stage. A statistically significant relationship was identified between perineural invasion, peritumoural inflammation, tumour stage, and the rate of cervical lymph node metastases in case of SCC of the larynx. Conclusion: Cervical lymph node metastases should be carefully investigated in the presence of perineural invasion and mild peritumoural inflammation in case of SCC of the larynx.

The paper presents a review of literature on the most unstudied problem in head and neck oncology — the diagnosis and treatment of patients with cervical lymph node metastases without a primary focus being detected.

Résumé La définition des volumes cibles ganglionnaires et/ou muqueux est actuellement non consensuelle dans le contexte d’adénopathies sans cancer primitif retrouvé. À l’extrême, les volumes sont, soit extensifs bilatéraux pan-muqueux, soit unilatéraux sélectifs et incluant ou pas la muqueuse oropharyngée seule. Cette revue expose les recommandations actuelles à la lumière des modifications de la classification TNM, du statut tumoral lié au papillomavirus humain et des avancées thérapeutiques. Nous avons réalisé une revue systématique de la littérature avec les mots clés : lymphadenopathy, head and neck, unknown primary, et radiation therapy. Il n’existe pas d’étude comparative directe entre irradiation ganglionnaire uni- ou bilatérale ni pan-muqueuse, muqueuse sélective ou non muqueuse. Les taux d’échec ganglionnaire controlatéral varient entre 0 et 6 % après irradiation unilatérale et 0 et 31 % après irradiation bilatérale. L’émergence d’un cancer primitif muqueux est très variable, entre 0 et 19,2 % selon les études. La présentation histoclinique initiale et le statut tumoral lié au papillomavirus humain sont très importants dans la sélection des volumes cibles muqueux. Une radiothérapie conformationnelle avec modulation d’intensité est recommandée pour limiter la toxicité. Les traitements systémiques ont les mêmes indications que les cancers de la tête et du cou de site primitif identifié. Les échecs ne semblent pas plus fréquents en cas d’irradiation unilatérale ganglionnaire, mais des études comparatives sont nécessaires. Le statut tumoral lié au papillomavirus humain est à rechercher et intégrer dans la stratégie thérapeutique et les changements de pratiques induits par la nouvelle classification TNM devront être évalués. Abstract The definition of nodal and/or mucosal target volumes for radiation therapy for lymphadenopathies of unknown primary is controversial. Target volumes may include all nodal areas bilaterraly and be pan-mucosal or unilateral, selective, including the sole oropharyngeal mucosa. This review presents current recommendations in light of changes in the TNM classification, Human papillomavirus status and therapeutic advances. We conducted a systematic review of the literature with the following keywords: lymphadenopathy; head and neck; unknown primary and radiation therapy. There are no direct comparative studies between unilateral or bilateral nodal irradiation or pan-mucosal and selective mucosal irradiation. Contralateral lymph node failure rates range from 0 to 6% after unilateral nodal irradiation and 0 and 31% after bilateral irradiation. Occurrence of a mucosal primary varies between 0 and 19.2%. Initial clinical presentation and Human papillomavirus status are critical to define mucosal target volumes. Intensity-modulated radiotherapy is recommended (rather than three-dimensional irradiation) to avoid toxicities. Systemic treatments have similar indications as for identified primary head and neck cancers. Failures do not appear superior in case of unilateral nodal irradiation but comparative studies are warranted due to major biases hampering direct comparisons. Human papillomavirus status should be incorporated into the therapeutic strategy and practice-changing TNM staging changes will need to be evaluated. [ABSTRACT FROM AUTHOR]

Introduction: Amongst all the malignant tumours, laryngeal cancer is found in 2.2% of males and 0.4% of females. Histopathologically, 90-95% of all laryngeal cancer is Squamous Cell Carcinoma (SCC). Tumour stage and cervical lymph node metastases are the most influential factors in determining a worsening prognosis. Aim: To investigate the relationship between perineural invasion, peritumoural inflammation, other commonly used prognostic parameters such as tumour stage, and cervical lymph node metastases in laryngeal SCC and contribute to the follow-up and treatment of patients. Materials and Methods: The pathology archive at Istanbul Sisli Hamidiye Etfal Education and Research Hospital was utilised for this research. Retrospective analysis was performed of data on 110 cases of laryngectomy and neck dissection specimens. Cases diagnosed as SCC were included in the study. Histopathologic analysis was conducted on the paraffinembedded tissue sections of 110 cases. The data were encoded, transmitted to a computer, and analysed using SPSS® 20.0. The Kruskal-Wallis H test was used to compare the groups. Statistical significance was considered to be p-value=<0.050. Results: The rate of cervical lymph node metastases was higher in the presence of perineural invasion, mild peritumoural inflammation, and advanced tumour stage. A statistically significant relationship was identified between perineural invasion, peritumoural inflammation, tumour stage, and the rate of cervical lymph node metastases in SCC of the larynx. Conclusion: Cervical lymph node metastases should be carefully investigated in the presence of perineural invasion and mild peritumoural inflammation in SCC of the larynx. [ABSTRACT FROM AUTHOR]

Background: To determine the impact of concurrent chemoradiotherapy (CCRT) with or without induction chemotherapy over radiation alone for the treatment of patients of cervical lymph node metastasis from an unknown primary tumor.Materials and Methods: A total of 96 patients with squamous cell histology of cervical lymph node metastases from unknown primary tumor were retrospectively reviewed. About 12 patients were treated with radiation alone (RT alone), 45 with CCRT, and 39 with induction chemotherapy followed by CCRT (ICCRT).Results: Overall response rate (ORR) obtained with RT alone arm was 75%, whereas for CCRT, it was 86.7%. About 15.4% had a complete response (CR) after induction chemotherapy with 92.3% ORR after the completion of CCRT. At 2 years, the disease free survival (DFS) was 50% in RT alone, 73% with CCRT, and 62% with ICCRT, while the corresponding rates at 5 years were 50% for RT alone, 45% with CCRT, and 54% in ICCRT arm.Conclusion: Though we obtained a high ORR with concurrent or induction chemotherapy arm over RT alone, there is no clear advantage in the DFS. The nonrandomized nature of this trial and the potential for selection bias should definitely be taken into account while drawing comparisons from this trial. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the additional value of cervical ultrasonography over 18F-FDG PET/CT for diagnosing cervical lymph node metastases in patients with newly diagnosed oesophageal cancer.Methods: Between January 2013 and January 2016, 163 patients with newly diagnosed oesophageal cancer underwent both cervical ultrasonography and 18F-FDG PET/CT at a tertiary referral centre in the Netherlands. Retrospective clinical data analysis was performed to assess the diagnostic value of cervical ultrasonography and 18F-FDG PET/CT for the detection of cervical lymph node metastases. Fine needle aspiration or clinical follow-up was used as reference standard.Results: The overall incidence of patients with cervical lymph node metastases was 14%. The sensitivity of 18F-FDG PET/CT to detect cervical lymph node metastases was 82% (95% CI 59-94%) and specificity was 91% (95% CI 85-95%). The sensitivity and specificity of cervical ultrasonography were 73% (95% CI 50-88%) and 84% (95% CI 77-90%), respectively. In patients with a negative 18F-FDG PET/CT, 12 of 133 (9%) patients had suspicious nodes on cervical ultrasonography. In all these 12 patients the nodes were confirmed benign.Conclusions: Cervical ultrasonography has no additional diagnostic value to a negative integrated 18F-FDG PET/CT for the detection of cervical lymph node metastases in patients with newly diagnosed oesophageal cancer.Key Points: • Cervical ultrasonography has no value over PET/CT in evaluating cervical node metastases. • PET/CT provides greater diagnostic confidence compared to cervical ultrasonography. • Cervical ultrasonography during standard diagnostic work-up may be considered unnecessary. • Cervical lesions on PET/CT require cytopathological confirmation by FNA. [ABSTRACT FROM AUTHOR]

Objectives: Human papilloma virus (HPV) is known to be associated with oropharyngeal squamous cell carcinomas (OPSCC) and may potentially play a vital role in tumor metastasis. The purpose of this study was to correlate HPV status of cervical lymph node metastases with their respective primary OPSCC tumor. Methods: Formalin-fixed, paraffin-embedded (FFPE) tissue samples obtained from 34 patients with cervical lymph node metastases were analyzed with HPV 16 DNA polymerase chain reaction (PCR), p16 immunohistochemistry and HPV typing. The results were correlated with the HPV status and type found in the primary tumors of OPSCC. Results: Comparing HPV DNA status with p16 we found that 21 primary tumors and lymph node metastases were HPV positive (61.8%) and seven primary tumors and lymph node metastases were HPV negative (20.6%). Six patient samples differed when correlating the primary tumor and lymph node metastasis (17.6%). Conclusions: In this study, HPV status in OPSCCs and their cervical lymph node metastases correlated in the vast majority of cases. However, HPV detection methods may have certain limitations resulting in varying degree of non-correlation. This should be taken into account when stratifying treatment in regard to HPV status. [ABSTRACT FROM AUTHOR]

FDG PET/CT is perceived as a valuable diagnostic tool in addition to the standard diagnostic workup for patients with isolated neck lymph nodes of squamous cell carcinoma of unknown primary (SCCUP). For patients with SCCUP intended for primary radiotherapy, we hypothesize that the previously reported FDG PET/CT detection rates are too high. From 2008 to 2015, 30 SCCUP patients were examined with FDG PET/CT. The objective of the FDG PET/CT examination was twofold: (1) improve the radiotherapy target definition, and (2) identify the primary cancer. Before the FDG PET/CT, the patients had been through a standard workup consisting of CT of the neck and chest, examination with flexible endoscopy with patient awake, panendoscopy and examination under general anesthesia, tonsillectomy and sometimes blind sampling biopsies, and MRI (floor of the mouth). All FDG PET/CTs were performed applying a flat table, head support and fixation mask as part of the radiotherapy treatment planning. Diagnostic CT with contrast was an integrated part of the PET/CT examination. Only 1/30 patients (cancer of the vallecula) had their primary cancer detected by FDG PET/CT. In addition, a non-biopsied patient with high uptake in the ipsilateral palatine tonsil was included, giving a detection rate of ≤7 % (95 % CI 2-21 %). In this retrospective study, we found that the FDG PET/CT detection rate of the primary for SCCUP patients is lower than previously reported. It is questionable whether FDG PET/CT is necessary for these patients when improved, advanced workup is available. [ABSTRACT FROM AUTHOR]

In patients with squamous cell carcinoma (SCC) metastases to neck lymph nodes and unknown primary tumor, the role of elective irradiation of uninvolved neck and potential mucosal primary sites is yet to be determined. The aim of this study was to review the experience treating SCC of unknown primary metastatic to neck nodes with surgery and postoperative radiotherapy (PORT) in Slovenia between 1995 and 2010 and to determine the importance of the extent of irradiated volume. For this purpose, the nationwide Cancer Registry of Slovenia database was used for identifying patients. 126 patients were identified. Involved-field PORT and extended-field PORT was used in 50 and 76 patients, respectively. At 5 years, locoregional control was 86 %, disease-specific survival 77 %, and overall survival 57 %. In multivariate analysis, the extent of irradiated volume has not been predictive for any outcome under study. Grade ≥3 acute and late radiotherapy-induced toxicities were more frequent in the extended-field PORT group. In conclusion, although not superior, involved-field PORT seems to be a preferred treatment option in SCC of unknown primary metastatic to neck nodes due to significantly reduced toxicity and better prospects for successful salvage. [ABSTRACT FROM AUTHOR]

Objective Little information is available as to whether recurrences of oral squamous cell carcinoma (OSCC) show different histopathological grades than the primary tumor and whether postoperative radiotherapy (PORT) influences the grade of differentiation in the case of recurrence. The objective of this study was the evaluation of recurrence rates and change in differentiation. Material and methods This retrospective, single-institution cohort study included surgically treated OSCC patients over a 13-year period (2000–2013). The relationship among tumor size, lymph node metastases, and recurrence rate of OSCC was investigated. Primary tumor differentiation was compared with differentiation of recurrence. Results A total of 429 patients (277 men and 152 women) were included in this study. Of these, 124 (28.9%) received PORT. The incidence of primary cervical metastases increased significantly with tumor size (p < 0.001). Recurrence developed in 82 patients (19.1%). Stage T1/T2 showed a significantly lower recurrence rate than stage T3/T4 (16.3% vs. 30.2%) (p < 0.01). A total of 23 (30.7%) patients with recurrence showed a change in differentiation. Conclusion Increasing primary tumor size correlates with incidence of cervical metastases and recurrence rate. Initial cervical metastases show no effect on recurrence rates. Differentiation of primary tumor does not correlate with the recurrence rate. The majority of recurrences show consistent histopathological grading. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the factors related to large-volume central cervical lymph node metastasis (LNM) in papillary thyroid carcinoma. A retrospective study of 340 patients with 642 papillary thyroid carcinoma nodules who underwent thyroidectomy in Peking Union Medical College Hospital between 2011 and 2015 was conducted. These nodules were divided into two groups by the number of central cervical lymph node metastases: large-volume central cervical LNM (>5 metastatic lymph nodes, n = 129) and no central cervical LNM ( n = 211). We evaluated the correlations between gender, age, chronic lymphocytic thyroiditis, thyroid ultrasonographic features, and large-volume central cervical LNM. We found that younger age (≤40 years) (OR = 3.796, 95% CI = 2.842, 5.070), male gender (OR = 4.005, 95% CI = 2.858, 5.61), and ultrasonographic features such as tumor macroaxis size (OR = 2.985, 95% CI = 1.581, 5.633), tumor located in the isthmus (OR = 7.578, 95% CI = 4.863, 11.810), ill-defined margin (OR = 3.008, 95% CI = 1.986, 4.556), microcalcification (OR = 2.155, 95% CI = 1.585, 2.929), and abnormal cervical lymph nodes (OR = 13.753, 95% CI = 9.278, 20.385) were independent risk factors for large-volume central cervical LNM in papillary thyroid carcinoma, while chronic lymphocytic thyroiditis (OR = 0.248, 95% CI = 0.172, 0.358) was a protective factor. Younger age (≤40 years), male sex, and ultrasonographic features such as tumor macroaxis size, tumor located in the isthmus, ill-defined margin, microcalcification, and abnormal cervical lymph nodes were independent risk factors for large-volume central cervical LNM in papillary thyroid carcinoma, while chronic lymphocytic thyroiditis can be considered a protective factor. Our results provide a reference for adjusting clinical treatment approaches., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer YW declared a shared affiliation with the authors to the handling editor at the time of review., (Copyright © 2022 Tan, Ji, Sharen, Liu and Lv.)

Metastasis in axillary and supraclavicular lymph nodes has been frequently observed in patients with breast cancer. The clinical staging and therapeutic principle determined according to the situation of lymph node metastasis are clear. One patient with infiltrating ductal carcinoma of the left breast was reported to undergo modified radical mastectomy. One and a half years later, lymphadenectasis was observed in area II, III, IV, V and VI of the left neck; therefore, cervical lymphadenectomy was performed under cervical plexus anesthesia, indicating lymph node metastatic adenocarcinoma (21/26). The patient took 10 mg tamoxifen twice per day for five years after lymphadenectomy and the review showed negative results in liver, lungs, mediastinum, neck and contralateral breast. This suggested that although breast cancer complicated with retrograde cervical lymph node metastases is rare, timely surgery is required even if the patient is in a good general condition, to avoid „delayed therapy” due to misjudgment of illness simply according to disease staging. [ABSTRACT FROM AUTHOR]

Background Cervical esophageal cancer (CEC) is a relatively rare disease but the outcomes of the patients with CEC are often poor. Lymph node metastases in the neck sometimes play a crucial role to treat the patients. The aim of this study is to evaluate the lymph node metastases and neck dissection for the patients with CEC. Methods Retrospective review of the records of the patients. Five patients with CEC who underwent total pahryngo-laryngectomy plus cervical esophagectomy were enrolled in this study. We analyzed the places of lymph node metastases of the patients and the relationship of the patients' outcome. Results Four of the patients underwent free jejunum flap reconstruction after total pahryngo-laryngectomy plus cervical esophagectomy and the other one underwent gastric tube plus free jejunum flap reconstruction after the pahryngo-laryngectomy plus total esophagectomy. All patients underwent bilateral neck dissection. One patient underwent chemoradiotherapy as an initial treatment and he had no lymph node metastasis by pathological examination. The other four patients had neck metastases to some extent. Three of them had bilateral lymph node metastases and the other had one metastatic lymph node. Especially one patient had left upper lateral neck metastasis and right Rouvier lymph node metastasis. Conclusion These results indicated that patients with CEC should undergo bilateral neck dissection and if possible, Rouvier lymph node should also be resected during radical surgery. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

The definition of nodal and/or mucosal target volumes for radiation therapy for lymphadenopathies of unknown primary is controversial. Target volumes may include all nodal areas bilaterraly and be pan-mucosal or unilateral, selective, including the sole oropharyngeal mucosa. This review presents current recommendations in light of changes in the TNM classification, Human papillomavirus status and therapeutic advances. We conducted a systematic review of the literature with the following keywords: lymphadenopathy; head and neck; unknown primary and radiation therapy. There are no direct comparative studies between unilateral or bilateral nodal irradiation or pan-mucosal and selective mucosal irradiation. Contralateral lymph node failure rates range from 0 to 6% after unilateral nodal irradiation and 0 and 31% after bilateral irradiation. Occurrence of a mucosal primary varies between 0 and 19.2%. Initial clinical presentation and Human papillomavirus status are critical to define mucosal target volumes. Intensity-modulated radiotherapy is recommended (rather than three-dimensional irradiation) to avoid toxicities. Systemic treatments have similar indications as for identified primary head and neck cancers. Failures do not appear superior in case of unilateral nodal irradiation but comparative studies are warranted due to major biases hampering direct comparisons. Human papillomavirus status should be incorporated into the therapeutic strategy and practice-changing TNM staging changes will need to be evaluated., (Copyright © 2018 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)

Fine-needle aspiration biopsy (FNAB) is often the first diagnostic procedure performed in patients with head and neck (HN) masses. Metastatic squamous cell carcinoma (SCC) to cervical lymph nodes is by far the most common malignancy aspirated in the HN, but in approximately 3-10% of patients, a primary tumor will not be found even after complete clinico-radiological workup. Several HN cancers are associated with oncogenic viruses, including HPV-associated SCC and EBV-associated nasopharyngeal carcinoma (NPC). While the primary tumor is sometimes small or undetectable, patients often present initially with cervical lymph node metastases. HPV-associated SCC and EBV-associated NPC are typically non-keratinizing carcinomas that can mimic several other poorly differentiated HN cancers by FNAB but have a significantly better prognosis. Therefore, the precise classification of the metastatic disease in the FNAB material is very useful since it can facilitate the subsequent location of the primary tumor, and it can provide prognostic and therapeutic information as well. In this review, we discuss the major entities that can present as a metastatic cancer of unknown primary in cervical lymph node other than supraclavicular, including their cytologic features and the role of ancillary studies., (Copyright © 2014 Elsevier Inc. All rights reserved.)