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To develop a deep learning model using transfer learning for automatic detection and segmentation of neck lymph nodes (LNs) in computed tomography (CT) images, the study included 11,013 annotated LNs with a short-axis diameter ≥ 3 mm from 626 head and neck cancer patients across four hospitals. The nnUNet model was used as a baseline, pre-trained on a large-scale head and neck dataset, and then fine-tuned with 4,729 LNs from hospital A for detection and segmentation. Validation was conducted on an internal testing cohort (ITC A) and three external testing cohorts (ETCs B, C, and D), with 1684 and 4600 LNs, respectively. Detection was evaluated via sensitivity, positive predictive value (PPV), and false positive rate per case (FP/vol), while segmentation was assessed using the Dice similarity coefficient (DSC) and Hausdorff distance (HD95). For detection, the sensitivity, PPV, and FP/vol in ITC A were 54.6%, 69.0%, and 3.4, respectively. In ETCs, the sensitivity ranged from 45.7% at 3.9 FP/vol to 63.5% at 5.8 FP/vol. Segmentation achieved a mean DSC of 0.72 in ITC A and 0.72 to 0.74 in ETCs, as well as a mean HD95 of 3.78 mm in ITC A and 2.73 mm to 2.85 mm in ETCs. No significant sensitivity difference was found between contrast-enhanced and unenhanced CT images (p = 0.502) or repeated CT images (p = 0.815) during adaptive radiotherapy. The model's segmentation accuracy was comparable to that of experienced oncologists. The model shows promise in automatically detecting and segmenting neck LNs in CT images, potentially reducing oncologists' segmentation workload. [ABSTRACT FROM AUTHOR]

Histiocytic sarcoma (HS) is an aggressive and rare hematological malignancy. Its treatment has not been established, and most patients die within 2 years of diagnosis. Resection can provide a favorable prognosis for solitary lesions. We present the case of an 80-year-old Japanese man with HS. He presented a history of a slow-growing painless mass in the lower part of his right jaw. Ultrasonography showed a swollen lymph node in the vicinity of the right submandibular gland. Contrast-enhanced computed tomography revealed a heterogeneous, low-contrast mass on the right of the neck. Magnetic resonance imaging revealed a heterogeneously enhanced mass in gadolinium-enhanced T1-weighted images. The fine needle biopsy showed spindle-shaped cells and HS was suspected. Fluorodeoxyglucose positron emission tomography revealed uptake by the tumor alone. The patient underwent right upper neck dissection and resection of the submandibular salivary glands. No postoperative adjuvant treatment was administered, but 2-year survival was achieved. Histopathological examination showed proliferation of large, pleomorphic atypical cells without differentiation into lymphocytes, which proved their differentiation into histiocytes. A bone marrow biopsy showed no evidence of monocytic leukemia. Thus, a diagnosis of HS was made. With local treatment alone, our patient achieved long-term survival, maintaining his quality of life. [ABSTRACT FROM AUTHOR]

This study aims to quantify the number of vascularized neck lymph nodes (VLNs) and postvascularized lymph node transfer (VLNT) and summarize the safety and efficacy of neck VLNT for treatment of lymphedema. PubMed, Web of Science, Google Scholar, and Cochrane CENTRAL databases were searched up to March 2022. PRISMA guidelines were adhered to, and the study was registered on PROSPERO. The primary outcome was the quantity of neck lymph nodes, and the secondary outcomes included postoperative cellulitis, Lymphedema Quality of Life Tool (LYMQOL), reduction of the extremity circumference, circumference differentiation, donor site morbidity, and lymphedema recurrence. The raw mean or proportion with a 95% confidence interval (CI) was calculated to conduct a single-arm meta-analysis. All analyses were performed using R software v4.0.3. Newcastle–Ottawa Scale was used to assess for quality of included studies. Eighteen studies comprising 510 patients were included in the single-arm meta-analysis. Mean neck VLNs were 3.80, 95% CI [2.48, 5.11], mean postoperative cellulitis was 0.70%, 95% CI [0.22, 1.18], mean postoperative LYMQOL was 6.84, 95% CI [5.39, 8.30], mean postoperative reduction of the extremity circumference 43.57%, 95% CI [27.81, 59.33], and mean circumference differentiation was 11.37%, 95% CI [7.51, 15.23]. The overall proportion of donor site morbidity events was 0.06, 95% CI [0.04, 0.11], and lymphedema recurrence was 0.12, 95% CI [0.05, 0.24]. The neck lymph node flap has an arsenal of lymph nodes present, carries no risk of iatrogenic edema, and has a low risk of other complications. Low donor site morbidity, patient satisfaction with the cosmetic scar, significant lymphedema reduction, and improvement of LYMQOL postoperatively are some positive outcomes that should be considered by surgeons. [ABSTRACT FROM AUTHOR]

Whether papillary carcinoma (PC) behavior is more aggressive in Graves’ disease (GD) patients than PC cases without GD is controversial. We retrospectively enrolled 33 thyroidectomized PC/GD patients during long-term follow-up, 23/33 without risk factors at surgery, and 18/33 microcarcinomas; 312 PC euthyroid-matched patients without risk factors served as controls. A total of 14/33 (42.4%) PC/GD patients, 4 with and 10 without risk factors at diagnosis, 6 with microcarcinoma, underwent metastases during follow-up. In controls, metastases in 21/312 (6.7%) were ascertained. Considering 10/23 PC/GD patients and 21/312 controls without risk factors who developed metastases, univariate analysis showed that there was an increased risk of metastasis appearance for PC/GD cases (p < 0.001). Disease-free survival (DFS) was significantly (p < 0.0001, log-rank test) shorter in PC/GD patients than in controls. Significantly more elevated aggressiveness in 6/18 PC/GD patients with microcarcinoma than in controls was also ascertained with shorter DFS. Thus, in the present study, PC/GD had aggressive behavior during follow-up also when carcinoma characteristics were favorable and some cases were microcarcinomas. GD and non-GD patient comparison in the cases without risk factors at diagnosis showed an increased risk to develop metastases in GD during follow-up, suggesting that GD alone might be a tumor aggressiveness predictive factor in these cases.

The diagnosis of primary hepatocellular carcinoma (HCC) in high risk patients, such as those with chronic hepatitis B or C with/without cirrhosis of the liver, can be made with relevant image studies alone; however, morphologic confirmation by cytology or histopathology is essential to the diagnosis of metastatic HCC because the treatment of the latter differs from that of primary extrahepatic malignancy. Although both cytology and histopathology are important tools in the diagnosis of malignancy, histopathology almost always plays a confirmatory and pivotal role, and also a gold standard in cyto-histological correlation. We present two patients of metastatic HCC to rare sites; endobronchus in one, and neck lymph nodes, face and the abdominal wall in the other. Repeated bronchial biopsy in the first patient and excisional biopsy from the metastatic sites of the second patient failed to make a conclusive diagnosis of metastatic HCC. However, bronchial brushing in the first patient and fine needle aspiration cytology from the respective metastatic sites of the second patient consistently showed characteristic HCC features and provided clinicians with the rationale for ongoing treatment. The diagnostic issues and possible pitfalls are discussed. Cytology and histopathology appear equipollent; sometimes cytology can play a diagnostic role when histopathology fails its expected role in this scenario. [ABSTRACT FROM AUTHOR]

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Purpose: Subclinical lymph node (LN) metastasis is associated with poor survival outcome in oral cavity squamous cell carcinoma (OCC), which alleges elective neck LN dissection. Preoperative detection of metastatic LNs may improve prognosis and proper management of OCC. We examined the clinical usefulness of fluorine 18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) for the detection of occult neck LN metastasis in OCC patients in comparison with conventional CT/magnetic resonance (MR) imaging. Methods: A total of 178 OCC patients with negative neck palpation findings were assessed prospectively with 18F-FDG PET/CT and CT/MR imaging. Histopathological analyses of neck dissection samples served as reference. Diagnostic values of 18F-FDG PET/CT versus CT/MR imaging were compared with the McNemar test and logistic regression with generalized estimating equations. Results: Forty-two patients (23.6%) had metastasis in 44 sides and 58 levels of the neck. The sensitivity for detection of occult metastasis was higher for 18F-FDG PET/CT than that for CT/MR imaging on a per-patient (69.1% vs 35.7%), per-side (70.5% vs 36.4%), and per-level (62.1% vs 29.3%) basis (all P ≤ 0.001). However, the specificity for metastatic detection was higher for CT/MR imaging than that for 18F-FDG PET/CT (all P < 0.005). 18F-FDG PET/CT improved detection of occult metastasis up to 33.4% in these patients compared to CT/MR imaging. Conclusions: 18F-FDG PET/CT can better detect occult neck metastasis than CT/MR imaging, which may potentially impact the clinical management of OCC patients. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the role of real-time sonoelastography (UE) and apparent diffusion coefficient (ADC) value measurement in differentiating benign versus malignant enlarged neck lymph nodes. Materials and methods: This study included 26 patients presented with 32 enlarged neck lymph nodes (LNs), underwent real-time UE and diffusion weighted MRI (DWI). ADC maps are generated from DWI and ADC values were calculated. Both UE and ADC findings were compared with histopathological results. Results: The LNs were 12 benign lymphadenopathy (37.5%, seen in 10 patients), 10 metastatic (31.25% seen in 8 patients) and 10 lymphoma (31.25%, seen in 8 patients) including 4 LNs with Hodgkin’s lymphoma (HL, seen in 3 patients) and 6 LNs with non Hodgkin’s lymphoma (NHL, seen in 5 patients). On UE 10 of the 12 benign LNs had pattern of 1–2 (83.3%) and 18 of 20 neoplastic LNs (90%) had pattern of 4–5. The mean ADC values of the benign, metastases and lymphoma groups were 1.52 ± 0.37, 0.90 ± 0.15 and 0.72 ± 0.12 × 10−3 (mm2/s), respectively. Conclusion: Combined real-time UE and ADC value measurement are non invasive techniques useful for differentiation of enlarged neck lymph. The combination potentially could reduce unnecessary biopsy especially for elasticity pattern 1–2.

Little is known about the pathological characteristics of metastatic and nonmetastatic lymph nodes (LNs) in papillary thyroid carcinoma (PTC). The aim of this study was to elucidate the pathological characteristics of neck level VI nodes and correlations with clinicopathological parameters. We investigated the clinicopathological features of 124 classical PTCs and characteristics of 850 dissected neck level VI LNs. Immunohistochemistry for nuclear factor-κB (NF-κB) and Ki-67 was performed on primary tumors, and correlations with nodal characteristics were investigated. Nodal metastasis at neck level VI was identified in 68 of 124 PTCs (54.8 %) and was significantly correlated with tumor size, tumor multifocality, extrathyroidal extension, and tumor stage. LN metastasis was significantly correlated with larger mean LN size ( P < 0.001), larger size of the largest LN ( P < 0.001), and more LNs ( P < 0.001). The mean size of metastatic LNs ( n = 233) was significantly larger than nonmetastatic LNs ( n = 617) ( P < 0.001). Primary tumor diameter significantly correlated with the largest LN size ( P = 0.014, R = 0.049), but not mean size or number of LNs by linear regression analysis. NF-κB and Ki-67 proliferation indexes were not significantly correlated with larger nodal size. These results suggested that characteristics of nodes and primary tumor would be useful criteria for making decisions about preoperative surveillance of nodal metastasis. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To evaluate the role of real-time sonoelastography (UE) and apparent diffusion coefficient (ADC) value measurement in differentiating benign versus malignant enlarged neck lymph nodes. Materials and methods: This study included 26 patients presented with 32 enlarged neck lymph nodes (LNs), underwent real-time UE and diffusion weighted MRI (DWI). ADC maps are generated from DWI and ADC values were calculated. Both UE and ADC findings were compared with histopathological results. Results: The LNs were 12 benign lymphadenopathy (37.5%, seen in 10 patients), 10 metastatic (31.25% seen in 8 patients) and 10 lymphoma (31.25%, seen in 8 patients) including 4 LNs with Hodgkin’s lymphoma (HL, seen in 3 patients) and 6 LNs with non Hodgkin’s lymphoma (NHL, seen in 5 patients). On UE 10 of the 12 benign LNs had pattern of 1–2 (83.3%) and 18 of 20 neoplastic LNs (90%) had pattern of 4–5. The mean ADC values of the benign, metastases and lymphoma groups were 1.52±0.37, 0.90±0.15 and 0.72±0.12×10−3 (mm2/s), respectively. Conclusion: Combined real-time UE and ADC value measurement are non invasive techniques useful for differentiation of enlarged neck lymph. The combination potentially could reduce unnecessary biopsy especially for elasticity pattern 1–2. [Copyright &y& Elsevier]

Purpose: To evaluate the prognostic value of preoperative neck lymph node (LN) assessment with 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), computed tomography (CT), and magnetic resonance imaging (MRI) in oral cavity squamous cell carcinoma (OSCC) patients with pathologically positive LN. Materials and Methods: In total, 47 OSCC patients with pathologically positive LN were retrospectively reviewed with preoperative 18F-FDG PET and CT/MRI. All patients underwent surgical resection, neck dissection and postoperative adjuvant radiotherapy and/or chemotherapy between March 2002 and October 2010. Histologic correlation was performed for findings of 18F-FDG PET and CT/MRI. Results: Thirty-six (76.6%) of 47 cases were correctly diagnosed with neck LN metastasis by 18F-FDG PET and 32 (68.1%) of 47 cases were correctly diagnosed by CT/MRI. Follow-up ranged from 20 to 114 months (median, 56 months). Clinically negative nodal status evaluated by 18F-FDG PET or CT/MRI revealed a trend toward better clinical outcomes in terms of overall survival, diseasefree survival, local recurrence-free survival, regional nodal recurrence-free survival, and distant metastasis-free survival rates even though the trends were not statistically significant. However, there was no impact of neck node standardized uptake value (SUVmax) on clinical outcomes. Notably, SUVmax showed significant correlation with tumor size in LN (p < 0.01, R² = 0.62). PET and CT/MRI status of LN also had significant correlation with the size of intranodal tumor deposit (p < 0.05, R² = 0.37 and p < 0.01, R² = 0.48, respectively). Conclusion: 18F-FDG PET and CT/MRI at the neck LNs might improve risk stratification in OSCC patients with pathologically positive neck LN in this study, even without significant prognostic value of SUVmax. [ABSTRACT FROM AUTHOR]

Background and Objectives: To compare US-guided core-needle biopsy (USCNB) and US-guided fine-needle aspiration (USFNA) of suspicious cervical lymph nodes for staging workup of malignancies in locations other than the head and neck using propensity score matching (PSM)., Methods: This retrospective cohort study included 108 patients who underwent USFNA and 1058 who underwent USCNB for suspicious cervical lymph nodes detected by imaging modalities during the staging workup for malignancies located in regions other than the head and neck. The primary outcome was defined as the inconclusive results. To evaluate the procedures according to the outcome, we performed univariate and multivariate logistic regression analyses and a 1:1 PSM of USCNB and USFNA., Results: There was no complication for both USFNA and USCNB. The inconclusive results were 6.5% (7/108) for USFNA and 1.6% (17/1058) for USCNB. A significantly lower rate of the inconclusive results in USCNB than in USFNA before matching was maintained after a 1:1 PSM of 103 patients from each group (before PSM, odds ratio (OR) = 4.489, 95% confidence interval (CI) [1.803-11.177], P = 0.001; after PSM, OR = 1.060, 95%CI [1.013-1.109], P = 0.012)., Conclusions: Because USCNB can reduce inconclusive results compared to USFNA, it could be more helpful for staging workup of malignancies in locations other than the head and neck in patients with suspicious cervical lymph nodes., (© 2017 Wiley Periodicals, Inc.)