BACKGROUND To evaluate the diagnostic utility of endobronchial ultrasound(EBUS)-guided mediastinal lymph node fenestration biopsy in atypical sarcoidosis using fine biopsy forceps[i.e.,EBUS-transbronchial forceps biop...BACKGROUND To evaluate the diagnostic utility of endobronchial ultrasound(EBUS)-guided mediastinal lymph node fenestration biopsy in atypical sarcoidosis using fine biopsy forceps[i.e.,EBUS-transbronchial forceps biopsy(TBFB)].CASE SUMMARY In this case series,two atypical sarcoidosis cases admitted in 2024 were retrospectively analyzed,both of whom lacked classical clinical manifestations.After chest computed tomography/positron emission tomography-computed tomography imaging and serum angiotensin-converting enzyme testing,EBUStransbronchial needle aspiration was performed using a 21-G needle.Subsequently,tissue sampling was performed at the enlarged puncture site by means of a 1.2-mm fine biopsy forceps.At the same time,bronchoalveolar lavage fluid lymphocyte subset analysis was conducted.CONCLUSION Both cases demonstrated non-caseating granulomatous inflammation on histopathology,elevated serum angiotensin-converting enzyme levels,and markedly increased CD4/CD8 ratios in bronchoalveolar lavage fluid.Case 1 was observed after confirmation of stage II sarcoidosis,whereas case 2 required glucocorticoid therapy due to the involvement of multiple systems.EBUS-TBFB can be used to make a definitive pathological diagnosis.For radiologically atypical sarcoidosis,EBUS-TBFB improves diagnostic accuracy by obtaining larger histological samples,thereby addressing the limitations of transbronchial needle aspiration cytology.This approach significantly improves differential diagnostic efficacy and holds substantial clinical relevance for broader adoption.展开更多
We report two cases of solitary mediastinal lymph node recurrence after colon cancer resection. Both cases had para-aortic lymph node metastasis at the time of initial surgery and received adjuvant chemotherapy for 4 ...We report two cases of solitary mediastinal lymph node recurrence after colon cancer resection. Both cases had para-aortic lymph node metastasis at the time of initial surgery and received adjuvant chemotherapy for 4 years in case 1 and 18 mo in case 2. The time to recurrence was more than 8 years in both cases. After resection of the recurrent tumor, the patient is doing well with no recurrence for 6 years in case 1 and 4 mo in case 2. Patients should be followed up after colon cancer surgery considering the possibility of solitary mediastinal lymph node recurrence if they had para-aortic node metastasis at the time of initial surgery.展开更多
Objective: To explore the change and feasibility of surgical techniques of laparoscopic transhiatal(TH)-lower mediastinal lymph node dissection(LMLND) for adenocarcinoma of the esophagogastric junction(AEG)according t...Objective: To explore the change and feasibility of surgical techniques of laparoscopic transhiatal(TH)-lower mediastinal lymph node dissection(LMLND) for adenocarcinoma of the esophagogastric junction(AEG)according to Idea, Development, Exploration, Assessment, and Long-term follow-up(IDEAL) 2a standards.Methods: Patients diagnosed with AEG who underwent laparoscopic TH-LMLND were prospectively included from April 14, 2020, to March 26, 2021. Clinical and pathological information as well as surgical outcomes were quantitatively analyzed. Semistructured interviews with the surgeon after each operation were qualitatively analyzed.Results: Thirty-five patients were included. There were no cases of transition to open surgery, but three cases involved combination with transthoracic surgery. In qualitative analysis, 108 items under three main themes were detected: explosion, dissection, and reconstruction. Revised instruction was subsequently designed according to the change in surgical technique and the cognitive process behind it. Three patients had anastomotic leaks postoperatively, with one classified as Clavien-Dindo Ⅲa.Conclusions: The surgical technique of laparoscopic TH-LMLND is stable and feasible;further IDEAL 2b research is warranted.展开更多
The mediastinal lymph node tuberculous abscesses（MLNTAs） are secondary to mediastinal tuberculous lymphadenitis. Surgical excision is often required when cold abscesses form. This study was aimed to examine video-as...The mediastinal lymph node tuberculous abscesses（MLNTAs） are secondary to mediastinal tuberculous lymphadenitis. Surgical excision is often required when cold abscesses form. This study was aimed to examine video-assisted thoracoscopic surgery（VATS） for the treatment of MLNTA. Clinical data of 16 MLNTA patients who were treated in our hospital between December 1, 2013 and December 1, 2015 were retrospectively analyzed. All of the patients underwent the radical debridement and drainage of abscesses, and intrathoracic lesions were removed by VATS. They were also administered the intensified anti-tuberculosis treatment（ATT）, and engaged in normal physical activity and follow-up for 3 to 6 months. The results showed that VATS was successfully attempted in all of the 16 MLNTA patients and they all had good recovery. Two patients developed complications after surgery, with one patient developing recurrent laryngeal nerve injury, and the other reporting poor wound healing. It was concluded that VATS is easy to perform, and safe, and has high rates of success and relatively few side-effects when used to treat MLNTA.展开更多
Objective: To investigate pathologically the characteristics of lung cancer metastasis by mediastinal lymph node ways (N2). Methods: Of 398 lung cancer patients who underwent radical pulmonectomy and extensive lymph n...Objective: To investigate pathologically the characteristics of lung cancer metastasis by mediastinal lymph node ways (N2). Methods: Of 398 lung cancer patients who underwent radical pulmonectomy and extensive lymph node dissection, 160 patients were diagnosed as with N2 metastasis, their 352 groups of mediastinal lymph nodes invaded were subject to the pathological study. Results: Evidences showed that the N2 metastasis of lung cancer was very active. It appears as single group or multi-group or jumping-form metastasis, rating 41.2%, 58.8% and 29.3% respectively. In addition, the extension of N2 metastasis was large, the most concentrated site was the 7th group lymph node (48.8%), then the 4th, 3rd and 5th group, rating 45.6%, 31.3% and 25.6% respectively. The occurrence of N2 metastasis was highly correlated with the site, size, histopathological type and the grade of differentiation of the cancer. An another feature of N2 metastasis was the invasion of metastasized lymph node into the bronchial wall, especially in adenocarcinoma. Conclusion: In order to achieve the radical removal of tumor, it is necessary to dissect the lymph nodes of the hilar and upper and lower mediastinum at the homolateral thoracic cavity actively and completely; beside, attention may be paid to the bronchial wall invasion caused by the lymph nodes metastasized.展开更多
Background The prognosis and survival of patients with lung cancer are likely to deteriorate with metastasis.Using deep-learning in the detection of lymph node metastasis can facilitate the noninvasive calculation of ...Background The prognosis and survival of patients with lung cancer are likely to deteriorate with metastasis.Using deep-learning in the detection of lymph node metastasis can facilitate the noninvasive calculation of the likelihood of such metastasis,thereby providing clinicians with crucial information to enhance diagnostic precision and ultimately improve patient survival and prognosis.Methods In total,623 eligible patients were recruited from two medical institutions.Seven deep learning models,namely Alex,GoogLeNet,Resnet18,Resnet101,Vgg16,Vgg19,and MobileNetv3(small),were utilized to extract deep image histological features.The dimensionality of the extracted features was then reduced using the Spearman correlation coefficient(r≥0.9)and Least Absolute Shrinkage and Selection Operator.Eleven machine learning methods,namely Support Vector Machine,K-nearest neighbor,Random Forest,Extra Trees,XGBoost,LightGBM,Naive Bayes,AdaBoost,Gradient Boosting Decision Tree,Linear Regression,and Multilayer Perceptron,were employed to construct classification prediction models for the filtered final features.The diagnostic performances of the models were assessed using various metrics,including accuracy,area under the receiver operating characteristic curve,sensitivity,specificity,positive predictive value,and negative predictive value.Calibration and decision-curve analyses were also performed.Results The present study demonstrated that using deep radiomic features extracted from Vgg16,in conjunction with a prediction model constructed via a linear regression algorithm,effectively distinguished the status of mediastinal lymph nodes in patients with lung cancer.The performance of the model was evaluated based on various metrics,including accuracy,area under the receiver operating characteristic curve,sensitivity,specificity,positive predictive value,and negative predictive value,which yielded values of 0.808,0.834,0.851,0.745,0.829,and 0.776,respectively.The validation set of the model was assessed using clinical decision curves,calibration curves,and confusion matrices,which collectively demonstrated the model's stability and accuracy.Conclusion In this study,information on the deep radiomics of Vgg16 was obtained from computed tomography images,and the linear regression method was able to accurately diagnose mediastinal lymph node metastases in patients with lung cancer.展开更多
Since the latest revision of the TNM system reclassified T3N0 tumours into the ⅡB stage, N2 lesions became the major determinant of the ⅢA stage. Concerning the minority of patients with T3N1 tumours in this stage,
Carcinoma of unknown primary (CUP) is occasionally encountered in clinical oncology. Wide variation exists in CUP. We herein report a rare case of CUP of a mediastinal lymph node. A 61-year-old man with dermatomyositi...Carcinoma of unknown primary (CUP) is occasionally encountered in clinical oncology. Wide variation exists in CUP. We herein report a rare case of CUP of a mediastinal lymph node. A 61-year-old man with dermatomyositis was referred to our hospital for treatment of mediastinal adenopathy and gastric cancer. Biopsy of both lesions showed that they were histologically different from each other. Mediastinal lymphadenectomy and total gastrectomy were performed for a definitive diagnosis and radical cure. Pathological examination revealed two distinctly different disease processes. The patient underwent postoperative chemotherapy for residual gastric cancer. Twenty months postoperatively, he is alive with cancer. Although CUP usually has a poor prognosis, surgical treatment of metastatic mediastinal lymph node CUP is a feasible therapeutic option.展开更多
Objective: Advances in diagnostic imaging techniques, such as 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), have led to greater accuracy in preoperative mediastinal staging for patients with non-small...Objective: Advances in diagnostic imaging techniques, such as 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), have led to greater accuracy in preoperative mediastinal staging for patients with non-small-cell lung cancer (NSCLC), but surgical staging remains the “gold standard” for diagnosis. A proper understanding of the current accuracy of diagnostic imaging is needed for further improvements. Methods: Forty-three patients who underwent resection for NSCLC involving mediastinal lymph node (MLN) metastasis at our hospital between June 2003 and May 2011 were enrolled in this study. We conducted a retrospective study of the radiological and pathological findings for 53 metastatic MLNs in the 43 patients. Results: The preoperative imaging modality was computed tomography (CT) alone for 18 patients (22 MLNs) and CT and FDG-PET for 25 patients (31 MLNs). The sensitivities of CT and FDG-PET were 41.5% and 58.0%, respectively. The sensitivity of CT did not differ according to any clinicopathological factors, but the sensitivity of FDG-PET tended to be higher for primary tumors with high SUVmax values and for non-adenocarcinomas. In the lymph nodes, all micrometastatic foci ≤ 2 mm were PET-negative, but 4 lymph nodes with metastatic foci larger than 10 mm were also PET-negative. Conclusions: For the diagnostic imaging of MLN, FDG-PET has a greater sensitivity than contrast-enhanced CT based on “size criteria”, but it is still not sufficiently sensitive and is influenced by various factors. At present, histological confirmation of MLNs is necessary when making decisions regarding treatment plans and the type of surgical procedure that should be performed.展开更多
AIM:To evaluate the ability of endoscopic ultrasound(EUS) elastography to distinguish benign from malignant pancreatic masses and lymph nodes.METHODS:A multicenter study was conducted and included 222 patients who und...AIM:To evaluate the ability of endoscopic ultrasound(EUS) elastography to distinguish benign from malignant pancreatic masses and lymph nodes.METHODS:A multicenter study was conducted and included 222 patients who underwent EUS examination with assessment of a pancreatic mass(n=121) or lymph node(n=101).The classification as benign or malignant,based on the real time elastography pattern,was compared with the classif ication based on the B-mode EUS images and with the fi nal diagnosis obtained by EUS-guided fi ne needle aspiration(EUS-FNA) and/or by surgical pathology.An interobserver study was performed.RESULTS:The sensitivity and specificity of EUS elastography to differentiate benign from malignant pancreatic lesions are 92.3% and 80.0%,respectively,compared to 92.3% and 68.9%,respectively,for the conventional B-mode images.The sensitivity and specificity of EUS elastography to differentiate benign from malignant lymph nodes was 91.8% and 82.5%,respectively,compared to 78.6% and 50.0%,respectively,for the B-mode images.The kappa coefficient was 0.785 for the pancreatic masses and 0.657 for the lymph nodes.CONCLUSION:EUS elastography is superior compared to conventional B-mode imaging and appears to be able to distinguish benign from malignant pancreatic masses and lymph nodes with a high sensitivity,specificity and accuracy.It might be reserved as a second line examination to help characterise pancreatic masses after negative EUS-FNA and might increase the yield of EUS-FNA for lymph nodes.展开更多
Lung cancer is the most common cancer worldwide. In the United States, it causes more cancer-related deaths than the next four causes （breast cancer, prostate cancer, colon cancer, and pancreatic cancer） of cancer-r...Lung cancer is the most common cancer worldwide. In the United States, it causes more cancer-related deaths than the next four causes （breast cancer, prostate cancer, colon cancer, and pancreatic cancer） of cancer-related mortality combined （1）. About 30% of people have already progressed to stage III lung cancer and 40% to stage IV at the time they are diagnosed （2）. Although chest X-ray and sputum cytology, when applied in health check-ups, can identify some relatively small tumors, they are not able to lower the overall mortality （3）. More recently,展开更多
Our aim is to evaluate the association between body mass index(BMI)and preoperative total testosterone(TT)levels with the risk of single and multiple metastatic lymph node invasion(LNI)in prostate cancer patients unde...Our aim is to evaluate the association between body mass index(BMI)and preoperative total testosterone(TT)levels with the risk of single and multiple metastatic lymph node invasion(LNI)in prostate cancer patients undergoing radical prostatectomy and extended pelvic lymph node dissection.Preoperative BMI,basal levels of TT,and prostate-specific antigen(PSA)were evaluated in 361 consecutive patients undergoing radical prostatectomy with extended pelvic lymph node dissection between 2014 and 2017・Patients were grouped into either nonmetastatic,one,or more than one metastatic lymph node invasion groups.The association among clinical factors and LNI was evaluated.LNI was detected in 52(14.4%)patients:28(7.8%)cases had one metastatic node and 24(6.6%)had more than one metastatic node.In the overall study population,BMI correlated inversely with TT(r=-0.256;P<0.0001).In patients without metastases,BMI inversely correlated with TT(r=-0.282;P<0.0001).In patients with metastasis,this correlation was lost.In the overall study population,BMI(odds ratio[OR]=1.268;P=0.005)was the only in dependent clinical factor associated with the risk of multiple metastatic LNI compared to cases with one metastatic node.In the nonmetastatic group,TT was lower in patients with BMI>28 kg m^2(P<0.0001).In patients with any LNI,this association was lost(P=0.232).The median number of positive nodes was higher in patients with BMI>28 kg m^2(P-0.048).In our study,overweight and obese patients had a higher risk of harboring multiple prostate cancer lymph node metastases and lower TT levels when compared to patients with normal BMI.展开更多
A novel coronavirus disease 2019(COVID-19)is a progressive viral disease that affected people around the world with widespread morbidity and mortality.Patients with COVID-19 infection typically had pulmonary manifesta...A novel coronavirus disease 2019(COVID-19)is a progressive viral disease that affected people around the world with widespread morbidity and mortality.Patients with COVID-19 infection typically had pulmonary manifestation but can also present with gastrointestinal,cardiac,or neurological system dysfunction.Chest imaging in patients with COVID-19 commonly show bilateral lung involvement with bilateral ground-glass opacity and consolidation.Mediastinal lymphadenopathy can be found due to infectious or non-infectious etiologies.It is commonly found to be associated with malignant diseases,sarcoidosis,and heart failure.Mediastinal lymph node enlargement is not a typical computer tomography of the chest finding of patients with COVID-19 infection.We summarized the literature which suggested or investigated the mediastinal lymph node enlargement in patients with COVID-19 infection.Further studies are needed to better characterize the importance of mediastinal lymphadenopathy in patients with COVID-19 infection.展开更多
Purpose:To explore the advantages of differentiating inflammatory from malignant thoracic lymph nodes by integrating their features onpositron emission tomography(PET)and computed tomography(CT).Material and method:Fo...Purpose:To explore the advantages of differentiating inflammatory from malignant thoracic lymph nodes by integrating their features onpositron emission tomography(PET)and computed tomography(CT).Material and method:Following institutional review board approval,PET and CT parameters of thoracic lymph nodes were examined based ontheir pathologic diagnosis via endobronchial ultrasound-guided transbronchial needle aspiration.The standardized uptake value(SUV)of PETand CT findings of the long-and short-axis diameters,axial short to long diameter ratios(S/L),and measured nodal CT values of the lymphnodes were compared and analyzed statistically.Results:A total of 124 lymph nodes from 70 patients were studied.The inflammatory and malignant lymph nodes differed significantly in theirSUV(P=0.008),short-axis diameters(SAD,p<0.001),long-axis diameters(LAD,p=0.002)and S/L ratios(p<0.001).They did not differsignificantly in non-contrast enhanced CT values(p=0.304).The sensitivities,specificities,positive predictive values,negative predictivevalues,diagnostic accuracies and diagnostic odds ratios(DOR)were:1)elevated SUV alone-95.31%(61/64),20%(12/60),55.96%(61/109),80%(12/15),58.87%(73/124),and 5;2)combined SUV+SAD-89.06%,53.33%,67.06%,82.05%,71.77%,and 9.31;3)combined SUV+S/L ratio-87.5%,93.33%,93.33%,87.5%,90.32%,and 98,respectively.Conclusion:Increased SUV,SAD,LAD,and S/L ratio are accurate PET/CT parameters to characterize inflammatory or malignant lymph nodes.SUV has high sensitivity but low specificity,low positive and negative predictive values,and low DOR.The SUV+SAD and SUV+S/L ratioshave higher specificity,positive and negative predictive values,diagnostic accuracy and DOR.展开更多
Background： Pathophysiological processes, such as malignancy, can lead to the formation of stiffer tissue in lung cancers. Endobronchial ultrasound rEBUS） elastography is a novel technique for measuring tissue stiff...Background： Pathophysiological processes, such as malignancy, can lead to the formation of stiffer tissue in lung cancers. Endobronchial ultrasound rEBUS） elastography is a novel technique for measuring tissue stiffness during EBUS-guided transbronchial needle aspiration （EBUS-TBNA）. The current study was conducted to investigate the diagnostic value of EBUS elastography tbr mediastinal and hilar lymph node metastasis in lung cancers. Methods： From January 2014 to January 2015, 40 patients suspected of lung cancer were enrolled, and a total of 68 lymph nodes were evaluated by EBUS-TBNA. EBUS-guided elastography of lymph nodes was perfornaed prior to EBUS-TBNA. Standard EBUS characteristics were also described. Pathological determination of malignant or benign lymph nodes was used as the gold standard for this study. If EBUS-TBNA did not result in a tbrmal pathological diagnosis of malignancy, patients were referred for a surgical procedure. Comparisons of elastography and standard EBUS characteristics were made between benign and malignant lymph nodes. Results： Elastography grading scores and strain ratios showed significant differences between benign and malignant lymph nodes （P = 0.000）. The elastography strain ratio was more sensitive and specific for determining malignant lymph nodes than elastography grading score or standard EBUS criteria. The receiver operating characteristic curve for the elastography strain ratio showed an area under the curve of 0.933. The best cut-off point of the strain ratio for differentiating malignant from benign lymph nodes was 32.07. The elastography strain ratio had a sensitivity of 88.1%, the specificity of 80.8%, positive predictive value of 88.1%, and negative predictive value of 80.8% for distinguishing malignant from benign nodes. The overall accuracy of elastography strain ratio was 85.3%. The strain ratio of malignant and benign lymph nodes positively correlated with the elastography grading score （r = 0.561, P = 0.000）. Conclusions： EBUS elastography can be effectively used to predict mediastinal and hilar lymph node metastases in lung cancer. This noninvasive technique may thus complement standard EBUS and help guide EBUS-TBNA procedures.展开更多
基金Supported by the National Natural Science Foundation of China,No.82170103Natural Science Foundation of Fujian Province,No.2024J011325+1 种基金Young People Training Project from Fujian Province Health Bureau,No.2020GGB057 and No.2023QNB008Xiamen Medical and Health Guidance Project,No.3502Z20224ZD1060,No.3502Z20214ZD1043,and No.3502Z20224ZD1058.
文摘BACKGROUND To evaluate the diagnostic utility of endobronchial ultrasound(EBUS)-guided mediastinal lymph node fenestration biopsy in atypical sarcoidosis using fine biopsy forceps[i.e.,EBUS-transbronchial forceps biopsy(TBFB)].CASE SUMMARY In this case series,two atypical sarcoidosis cases admitted in 2024 were retrospectively analyzed,both of whom lacked classical clinical manifestations.After chest computed tomography/positron emission tomography-computed tomography imaging and serum angiotensin-converting enzyme testing,EBUStransbronchial needle aspiration was performed using a 21-G needle.Subsequently,tissue sampling was performed at the enlarged puncture site by means of a 1.2-mm fine biopsy forceps.At the same time,bronchoalveolar lavage fluid lymphocyte subset analysis was conducted.CONCLUSION Both cases demonstrated non-caseating granulomatous inflammation on histopathology,elevated serum angiotensin-converting enzyme levels,and markedly increased CD4/CD8 ratios in bronchoalveolar lavage fluid.Case 1 was observed after confirmation of stage II sarcoidosis,whereas case 2 required glucocorticoid therapy due to the involvement of multiple systems.EBUS-TBFB can be used to make a definitive pathological diagnosis.For radiologically atypical sarcoidosis,EBUS-TBFB improves diagnostic accuracy by obtaining larger histological samples,thereby addressing the limitations of transbronchial needle aspiration cytology.This approach significantly improves differential diagnostic efficacy and holds substantial clinical relevance for broader adoption.
基金Supported by Department of Surgery,Osaka Medical Center for Cancer and Cardiovascular Disease,Osaka 537-8511,Japan
文摘We report two cases of solitary mediastinal lymph node recurrence after colon cancer resection. Both cases had para-aortic lymph node metastasis at the time of initial surgery and received adjuvant chemotherapy for 4 years in case 1 and 18 mo in case 2. The time to recurrence was more than 8 years in both cases. After resection of the recurrent tumor, the patient is doing well with no recurrence for 6 years in case 1 and 4 mo in case 2. Patients should be followed up after colon cancer surgery considering the possibility of solitary mediastinal lymph node recurrence if they had para-aortic node metastasis at the time of initial surgery.
基金supportedbyBeijing Municipal Administration of Hospitals(No.DFL20181103)Beijing Hospitals Authority Innovation Studio of Young Staff Funding Support(No.202123).
文摘Objective: To explore the change and feasibility of surgical techniques of laparoscopic transhiatal(TH)-lower mediastinal lymph node dissection(LMLND) for adenocarcinoma of the esophagogastric junction(AEG)according to Idea, Development, Exploration, Assessment, and Long-term follow-up(IDEAL) 2a standards.Methods: Patients diagnosed with AEG who underwent laparoscopic TH-LMLND were prospectively included from April 14, 2020, to March 26, 2021. Clinical and pathological information as well as surgical outcomes were quantitatively analyzed. Semistructured interviews with the surgeon after each operation were qualitatively analyzed.Results: Thirty-five patients were included. There were no cases of transition to open surgery, but three cases involved combination with transthoracic surgery. In qualitative analysis, 108 items under three main themes were detected: explosion, dissection, and reconstruction. Revised instruction was subsequently designed according to the change in surgical technique and the cognitive process behind it. Three patients had anastomotic leaks postoperatively, with one classified as Clavien-Dindo Ⅲa.Conclusions: The surgical technique of laparoscopic TH-LMLND is stable and feasible;further IDEAL 2b research is warranted.
文摘The mediastinal lymph node tuberculous abscesses（MLNTAs） are secondary to mediastinal tuberculous lymphadenitis. Surgical excision is often required when cold abscesses form. This study was aimed to examine video-assisted thoracoscopic surgery（VATS） for the treatment of MLNTA. Clinical data of 16 MLNTA patients who were treated in our hospital between December 1, 2013 and December 1, 2015 were retrospectively analyzed. All of the patients underwent the radical debridement and drainage of abscesses, and intrathoracic lesions were removed by VATS. They were also administered the intensified anti-tuberculosis treatment（ATT）, and engaged in normal physical activity and follow-up for 3 to 6 months. The results showed that VATS was successfully attempted in all of the 16 MLNTA patients and they all had good recovery. Two patients developed complications after surgery, with one patient developing recurrent laryngeal nerve injury, and the other reporting poor wound healing. It was concluded that VATS is easy to perform, and safe, and has high rates of success and relatively few side-effects when used to treat MLNTA.
文摘Objective: To investigate pathologically the characteristics of lung cancer metastasis by mediastinal lymph node ways (N2). Methods: Of 398 lung cancer patients who underwent radical pulmonectomy and extensive lymph node dissection, 160 patients were diagnosed as with N2 metastasis, their 352 groups of mediastinal lymph nodes invaded were subject to the pathological study. Results: Evidences showed that the N2 metastasis of lung cancer was very active. It appears as single group or multi-group or jumping-form metastasis, rating 41.2%, 58.8% and 29.3% respectively. In addition, the extension of N2 metastasis was large, the most concentrated site was the 7th group lymph node (48.8%), then the 4th, 3rd and 5th group, rating 45.6%, 31.3% and 25.6% respectively. The occurrence of N2 metastasis was highly correlated with the site, size, histopathological type and the grade of differentiation of the cancer. An another feature of N2 metastasis was the invasion of metastasized lymph node into the bronchial wall, especially in adenocarcinoma. Conclusion: In order to achieve the radical removal of tumor, it is necessary to dissect the lymph nodes of the hilar and upper and lower mediastinum at the homolateral thoracic cavity actively and completely; beside, attention may be paid to the bronchial wall invasion caused by the lymph nodes metastasized.
基金the Science and Technology Funding Project of Hunan Province,China(2023JJ50410)(HX)Key Laboratory of Tumor Precision Medicine,Hunan colleges and Universities Project(2019-379)(QL).
文摘Background The prognosis and survival of patients with lung cancer are likely to deteriorate with metastasis.Using deep-learning in the detection of lymph node metastasis can facilitate the noninvasive calculation of the likelihood of such metastasis,thereby providing clinicians with crucial information to enhance diagnostic precision and ultimately improve patient survival and prognosis.Methods In total,623 eligible patients were recruited from two medical institutions.Seven deep learning models,namely Alex,GoogLeNet,Resnet18,Resnet101,Vgg16,Vgg19,and MobileNetv3(small),were utilized to extract deep image histological features.The dimensionality of the extracted features was then reduced using the Spearman correlation coefficient(r≥0.9)and Least Absolute Shrinkage and Selection Operator.Eleven machine learning methods,namely Support Vector Machine,K-nearest neighbor,Random Forest,Extra Trees,XGBoost,LightGBM,Naive Bayes,AdaBoost,Gradient Boosting Decision Tree,Linear Regression,and Multilayer Perceptron,were employed to construct classification prediction models for the filtered final features.The diagnostic performances of the models were assessed using various metrics,including accuracy,area under the receiver operating characteristic curve,sensitivity,specificity,positive predictive value,and negative predictive value.Calibration and decision-curve analyses were also performed.Results The present study demonstrated that using deep radiomic features extracted from Vgg16,in conjunction with a prediction model constructed via a linear regression algorithm,effectively distinguished the status of mediastinal lymph nodes in patients with lung cancer.The performance of the model was evaluated based on various metrics,including accuracy,area under the receiver operating characteristic curve,sensitivity,specificity,positive predictive value,and negative predictive value,which yielded values of 0.808,0.834,0.851,0.745,0.829,and 0.776,respectively.The validation set of the model was assessed using clinical decision curves,calibration curves,and confusion matrices,which collectively demonstrated the model's stability and accuracy.Conclusion In this study,information on the deep radiomics of Vgg16 was obtained from computed tomography images,and the linear regression method was able to accurately diagnose mediastinal lymph node metastases in patients with lung cancer.
文摘Since the latest revision of the TNM system reclassified T3N0 tumours into the ⅡB stage, N2 lesions became the major determinant of the ⅢA stage. Concerning the minority of patients with T3N1 tumours in this stage,
文摘Carcinoma of unknown primary (CUP) is occasionally encountered in clinical oncology. Wide variation exists in CUP. We herein report a rare case of CUP of a mediastinal lymph node. A 61-year-old man with dermatomyositis was referred to our hospital for treatment of mediastinal adenopathy and gastric cancer. Biopsy of both lesions showed that they were histologically different from each other. Mediastinal lymphadenectomy and total gastrectomy were performed for a definitive diagnosis and radical cure. Pathological examination revealed two distinctly different disease processes. The patient underwent postoperative chemotherapy for residual gastric cancer. Twenty months postoperatively, he is alive with cancer. Although CUP usually has a poor prognosis, surgical treatment of metastatic mediastinal lymph node CUP is a feasible therapeutic option.
文摘Objective: Advances in diagnostic imaging techniques, such as 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), have led to greater accuracy in preoperative mediastinal staging for patients with non-small-cell lung cancer (NSCLC), but surgical staging remains the “gold standard” for diagnosis. A proper understanding of the current accuracy of diagnostic imaging is needed for further improvements. Methods: Forty-three patients who underwent resection for NSCLC involving mediastinal lymph node (MLN) metastasis at our hospital between June 2003 and May 2011 were enrolled in this study. We conducted a retrospective study of the radiological and pathological findings for 53 metastatic MLNs in the 43 patients. Results: The preoperative imaging modality was computed tomography (CT) alone for 18 patients (22 MLNs) and CT and FDG-PET for 25 patients (31 MLNs). The sensitivities of CT and FDG-PET were 41.5% and 58.0%, respectively. The sensitivity of CT did not differ according to any clinicopathological factors, but the sensitivity of FDG-PET tended to be higher for primary tumors with high SUVmax values and for non-adenocarcinomas. In the lymph nodes, all micrometastatic foci ≤ 2 mm were PET-negative, but 4 lymph nodes with metastatic foci larger than 10 mm were also PET-negative. Conclusions: For the diagnostic imaging of MLN, FDG-PET has a greater sensitivity than contrast-enhanced CT based on “size criteria”, but it is still not sufficiently sensitive and is influenced by various factors. At present, histological confirmation of MLNs is necessary when making decisions regarding treatment plans and the type of surgical procedure that should be performed.
文摘AIM:To evaluate the ability of endoscopic ultrasound(EUS) elastography to distinguish benign from malignant pancreatic masses and lymph nodes.METHODS:A multicenter study was conducted and included 222 patients who underwent EUS examination with assessment of a pancreatic mass(n=121) or lymph node(n=101).The classification as benign or malignant,based on the real time elastography pattern,was compared with the classif ication based on the B-mode EUS images and with the fi nal diagnosis obtained by EUS-guided fi ne needle aspiration(EUS-FNA) and/or by surgical pathology.An interobserver study was performed.RESULTS:The sensitivity and specificity of EUS elastography to differentiate benign from malignant pancreatic lesions are 92.3% and 80.0%,respectively,compared to 92.3% and 68.9%,respectively,for the conventional B-mode images.The sensitivity and specificity of EUS elastography to differentiate benign from malignant lymph nodes was 91.8% and 82.5%,respectively,compared to 78.6% and 50.0%,respectively,for the B-mode images.The kappa coefficient was 0.785 for the pancreatic masses and 0.657 for the lymph nodes.CONCLUSION:EUS elastography is superior compared to conventional B-mode imaging and appears to be able to distinguish benign from malignant pancreatic masses and lymph nodes with a high sensitivity,specificity and accuracy.It might be reserved as a second line examination to help characterise pancreatic masses after negative EUS-FNA and might increase the yield of EUS-FNA for lymph nodes.
文摘Lung cancer is the most common cancer worldwide. In the United States, it causes more cancer-related deaths than the next four causes （breast cancer, prostate cancer, colon cancer, and pancreatic cancer） of cancer-related mortality combined （1）. About 30% of people have already progressed to stage III lung cancer and 40% to stage IV at the time they are diagnosed （2）. Although chest X-ray and sputum cytology, when applied in health check-ups, can identify some relatively small tumors, they are not able to lower the overall mortality （3）. More recently,
文摘Our aim is to evaluate the association between body mass index(BMI)and preoperative total testosterone(TT)levels with the risk of single and multiple metastatic lymph node invasion(LNI)in prostate cancer patients undergoing radical prostatectomy and extended pelvic lymph node dissection.Preoperative BMI,basal levels of TT,and prostate-specific antigen(PSA)were evaluated in 361 consecutive patients undergoing radical prostatectomy with extended pelvic lymph node dissection between 2014 and 2017・Patients were grouped into either nonmetastatic,one,or more than one metastatic lymph node invasion groups.The association among clinical factors and LNI was evaluated.LNI was detected in 52(14.4%)patients:28(7.8%)cases had one metastatic node and 24(6.6%)had more than one metastatic node.In the overall study population,BMI correlated inversely with TT(r=-0.256;P<0.0001).In patients without metastases,BMI inversely correlated with TT(r=-0.282;P<0.0001).In patients with metastasis,this correlation was lost.In the overall study population,BMI(odds ratio[OR]=1.268;P=0.005)was the only in dependent clinical factor associated with the risk of multiple metastatic LNI compared to cases with one metastatic node.In the nonmetastatic group,TT was lower in patients with BMI>28 kg m^2(P<0.0001).In patients with any LNI,this association was lost(P=0.232).The median number of positive nodes was higher in patients with BMI>28 kg m^2(P-0.048).In our study,overweight and obese patients had a higher risk of harboring multiple prostate cancer lymph node metastases and lower TT levels when compared to patients with normal BMI.
文摘A novel coronavirus disease 2019(COVID-19)is a progressive viral disease that affected people around the world with widespread morbidity and mortality.Patients with COVID-19 infection typically had pulmonary manifestation but can also present with gastrointestinal,cardiac,or neurological system dysfunction.Chest imaging in patients with COVID-19 commonly show bilateral lung involvement with bilateral ground-glass opacity and consolidation.Mediastinal lymphadenopathy can be found due to infectious or non-infectious etiologies.It is commonly found to be associated with malignant diseases,sarcoidosis,and heart failure.Mediastinal lymph node enlargement is not a typical computer tomography of the chest finding of patients with COVID-19 infection.We summarized the literature which suggested or investigated the mediastinal lymph node enlargement in patients with COVID-19 infection.Further studies are needed to better characterize the importance of mediastinal lymphadenopathy in patients with COVID-19 infection.
文摘Purpose:To explore the advantages of differentiating inflammatory from malignant thoracic lymph nodes by integrating their features onpositron emission tomography(PET)and computed tomography(CT).Material and method:Following institutional review board approval,PET and CT parameters of thoracic lymph nodes were examined based ontheir pathologic diagnosis via endobronchial ultrasound-guided transbronchial needle aspiration.The standardized uptake value(SUV)of PETand CT findings of the long-and short-axis diameters,axial short to long diameter ratios(S/L),and measured nodal CT values of the lymphnodes were compared and analyzed statistically.Results:A total of 124 lymph nodes from 70 patients were studied.The inflammatory and malignant lymph nodes differed significantly in theirSUV(P=0.008),short-axis diameters(SAD,p<0.001),long-axis diameters(LAD,p=0.002)and S/L ratios(p<0.001).They did not differsignificantly in non-contrast enhanced CT values(p=0.304).The sensitivities,specificities,positive predictive values,negative predictivevalues,diagnostic accuracies and diagnostic odds ratios(DOR)were:1)elevated SUV alone-95.31%(61/64),20%(12/60),55.96%(61/109),80%(12/15),58.87%(73/124),and 5;2)combined SUV+SAD-89.06%,53.33%,67.06%,82.05%,71.77%,and 9.31;3)combined SUV+S/L ratio-87.5%,93.33%,93.33%,87.5%,90.32%,and 98,respectively.Conclusion:Increased SUV,SAD,LAD,and S/L ratio are accurate PET/CT parameters to characterize inflammatory or malignant lymph nodes.SUV has high sensitivity but low specificity,low positive and negative predictive values,and low DOR.The SUV+SAD and SUV+S/L ratioshave higher specificity,positive and negative predictive values,diagnostic accuracy and DOR.
文摘Background： Pathophysiological processes, such as malignancy, can lead to the formation of stiffer tissue in lung cancers. Endobronchial ultrasound rEBUS） elastography is a novel technique for measuring tissue stiffness during EBUS-guided transbronchial needle aspiration （EBUS-TBNA）. The current study was conducted to investigate the diagnostic value of EBUS elastography tbr mediastinal and hilar lymph node metastasis in lung cancers. Methods： From January 2014 to January 2015, 40 patients suspected of lung cancer were enrolled, and a total of 68 lymph nodes were evaluated by EBUS-TBNA. EBUS-guided elastography of lymph nodes was perfornaed prior to EBUS-TBNA. Standard EBUS characteristics were also described. Pathological determination of malignant or benign lymph nodes was used as the gold standard for this study. If EBUS-TBNA did not result in a tbrmal pathological diagnosis of malignancy, patients were referred for a surgical procedure. Comparisons of elastography and standard EBUS characteristics were made between benign and malignant lymph nodes. Results： Elastography grading scores and strain ratios showed significant differences between benign and malignant lymph nodes （P = 0.000）. The elastography strain ratio was more sensitive and specific for determining malignant lymph nodes than elastography grading score or standard EBUS criteria. The receiver operating characteristic curve for the elastography strain ratio showed an area under the curve of 0.933. The best cut-off point of the strain ratio for differentiating malignant from benign lymph nodes was 32.07. The elastography strain ratio had a sensitivity of 88.1%, the specificity of 80.8%, positive predictive value of 88.1%, and negative predictive value of 80.8% for distinguishing malignant from benign nodes. The overall accuracy of elastography strain ratio was 85.3%. The strain ratio of malignant and benign lymph nodes positively correlated with the elastography grading score （r = 0.561, P = 0.000）. Conclusions： EBUS elastography can be effectively used to predict mediastinal and hilar lymph node metastases in lung cancer. This noninvasive technique may thus complement standard EBUS and help guide EBUS-TBNA procedures.
