The principal breast cancer treatment approach has long been surgical removal of the primary breast lesions and regional lymph nodes,particularly the axillary lymph nodes.However,the advent of minimally invasive diagn...The principal breast cancer treatment approach has long been surgical removal of the primary breast lesions and regional lymph nodes,particularly the axillary lymph nodes.However,the advent of minimally invasive diagnostic techniques,such as sentinel lymph node biopsy(SLNB),has markedly diminished the extent of surgery required for regional lymph nodes.展开更多
BACKGROUND Lymph node status is a critical prognostic factor in gastric cancer(GC),but stage migration may occur in pathological lymph nodes(pN)staging.To address this,alternative staging systems such as the positive ...BACKGROUND Lymph node status is a critical prognostic factor in gastric cancer(GC),but stage migration may occur in pathological lymph nodes(pN)staging.To address this,alternative staging systems such as the positive lymph node ratio(LNR)and log odds of positive lymph nodes(LODDS)were introduced.AIM To assess the prognostic accuracy and stratification efficacy of three nodal staging systems in GC.METHODS A systematic review identified 12 studies,from which hazard ratios(HRs)for overall survival(OS)were summarized.Sensitivity analyses,subgroup analyses,publication bias assessments,and quality evaluations were conducted.To enhance comparability,data from studies with identical cutoff values for pN,LNR,and LODDS were pooled.Homogeneous stratification was then applied to generate Kaplan-Meier(KM)survival curves,assessing the stratification efficacy of three staging systems.RESULTS The HRs and 95%confidence intervals for pN,LNR,and LODDS were 2.16(1.72-2.73),2.05(1.65-2.55),and 3.15(2.15-4.37),respectively,confirming all three as independent prognostic risk factors for OS.Comparative analysis of HRs demonstrated that LODDS had superior prognostic predictive power over LNR and pN.KM curves for pN(N0,N1,N2,N3a,N3b),LNR(0.1/0.2/0.5),and LODDS(-1.5/-1.0/-0.5/0)revealed significant differences(P<0.001)among all prognostic stratifications.Mean differences and standard deviations in 60-month relative survival were 27.93%±0.29%,41.70%±0.30%,and 26.60%±0.28%for pN,LNR,and LODDS,respectively.CONCLUSION All three staging systems are independent prognostic factors for OS.LODDS demonstrated the highest specificity,making it especially useful for predicting outcomes,while pN was the most effective in homogeneous stratification,offering better patient differentiation.These findings highlight the complementary roles of LODDS and pN in enhancing prognostic accuracy and stratification.展开更多
Introduction The accuracy of sentinel lymph node biopsy(SLNB)after neoadjuvant therapy(NAT)has been confirmed in clinical nodal stage 1(c N1)patients,and more patients could benefit from axillary surgery de-escalation...Introduction The accuracy of sentinel lymph node biopsy(SLNB)after neoadjuvant therapy(NAT)has been confirmed in clinical nodal stage 1(c N1)patients,and more patients could benefit from axillary surgery de-escalation after NAT(1,2).展开更多
Background:Metastasis to the infraclavicular and supraclavicular lymph nodes(ISLNs)is an important factor that predicts poor survival in patients with breast cancer;however,pathological nodal staging does not traditio...Background:Metastasis to the infraclavicular and supraclavicular lymph nodes(ISLNs)is an important factor that predicts poor survival in patients with breast cancer;however,pathological nodal staging does not traditionally include ISLNs because of their non-routine surgical dissection.This study aimed to evaluate the prognostic impact of ISLN metastasis and propose a refined nodal staging system tailored for patients undergoing neoadjuvant chemotherapy(NAC).Methods:We retrospectively reviewed 1,072 patients with breast cancer with or without ISLN metastasis who received NAC at two institutions(Fujian cohort and Hebei cohort)from 2010 to 2022.We conducted detailed survival analysis to evaluate the diagnostic consistency and prognostic significance of ISLNs.Results:There were no survival differences among patients with ISLN involvement across different assay method-ologies and patient cohorts.Among 887 patients in the Fujian cohort,238 patients(26.8%)with positive ISLNs had significantly inferior 3-year progression-free survival(PFS,75.9%vs.90.4%,P<0.001)and overall survival(OS,90.6%vs.95.9%,P<0.001).After adjusting for potential confounders,ISLN involvement persisted as an independent predictor of both PFS and OS.We propose a refined axillary classification that combines pathologi-cal axillary staging post-NAC with ISLN involvement,revealing 3-year PFS rates of 95.3%,87.6%,73.4%,and 64.5%for the respective four groups defined by this refined classification combining axillary stage and ISLN status.Conclusions:Involvement of the ISLNs was associated with a worse prognosis,underscoring their prognostic value.This finding highlights the potential of ISLN status to influence decisions regarding adjuvant treatment in patients with breast cancer.展开更多
BACKGROUND One of the main characteristics of oral squamous cell carcinoma(OSCC)is that it metastasizes to cervical lymph nodes frequently with a high degree of local invasiveness.A primary feature of malignant tumors...BACKGROUND One of the main characteristics of oral squamous cell carcinoma(OSCC)is that it metastasizes to cervical lymph nodes frequently with a high degree of local invasiveness.A primary feature of malignant tumors is their penetration of neighboring tissues,such as lymphatic and blood arteries,due to the tumor cells'capacity to break down the extracellular matrix(ECM).Matrix metalloproteinases(MMPs)constitute a family of proteolytic enzymes that facilitate tissue remodeling and the degradation of the ECM.MMP-9 and MMP-13 belong to the group of extracellular matrix degrading enzymes and their expression has been studied in OSCC because of their specific functions.MMP-13,a collagenase family member,is thought to play an essential role in the MMP activation cascade by breaking down the fibrillar collagens,whereas MMP-9 is thought to accelerate the growth of tumors.Elevated MMP-13 expression has been associated with tumor behavior and patient prognosis in a number of malignant cases.AIM To assess the immunohistochemical expression of MMP-9 and MMP-13 in OSCC.METHODS A total of 40 cases with histologically confirmed OSCC by incisional biopsy were included in this cross-sectional retrospective study.The protocols for both MMP-9 and MMP-13 immunohistochemical staining were performed according to the manufacturer’s recommendations along with the normal gingival epithelium as a positive control.All the observations were recorded and Pearson’sχ²test with Fisher exact test was used for statistical analysis.RESULTS Our study showed no significant correlation between MMP-9 and MMP-13 staining intensity and tumor size.The majority of the patients were in advanced TNM stages(III and IV),and showed intense expression of MMP-9 and MMP-13.CONCLUSION The present study suggests that both MMP-9 and MMP-13 play an important and independent role in OSCC progression and invasiveness.Intense expression of MMP-9 and MMP-13,irrespective of histological grade of OSCC,correlates well with TNM stage.Consequently,it is evident that MMP-9 and MMP-13 are important for the invasiveness and progression of tumors.The findings may facilitate the development of new approaches for evaluating lymph node metastases and interventional therapy techniques,hence enhancing the prognosis of patients diagnosed with OSCC.展开更多
Imaging evaluation of lymph node metastasis and infiltration faces problems such as low artificial outline efficiency and insufficient consistency.Deep learning technology based on convolutional neural networks has gr...Imaging evaluation of lymph node metastasis and infiltration faces problems such as low artificial outline efficiency and insufficient consistency.Deep learning technology based on convolutional neural networks has greatly improved the technical effect of radiomics in lymph node pathological characteristics analysis and efficacy monitoring through automatic lymph node detection,precise segmentation and three-dimensional reconstruction algorithms.This review focuses on the automatic lymph node segmentation model,treatment response prediction algorithm and benign and malignant differential diagnosis system for multimodal imaging,in order to provide a basis for further research on artificial intelligence to assist lymph node disease management and clinical decision-making,and provide a reference for promoting the construction of a system for accurate diagnosis,personalized treatment and prognostic evaluation of lymph node-related diseases.展开更多
Accurate preoperative prediction of lymph node metastasis is crucial for developing clinical management strategies for patients with esophageal cancer.In this letter,we present our insights and opinions on a new nomog...Accurate preoperative prediction of lymph node metastasis is crucial for developing clinical management strategies for patients with esophageal cancer.In this letter,we present our insights and opinions on a new nomogram proposed by Xu et al.Although this research has great potential,there are still concerns re-garding the small sample size,limited consideration of biological complexity,subjective image segmentation,incomplete image feature extraction and statistical analyses.Furthermore,we discuss how to achieve more robust and accurate predictive performance in future research.展开更多
BACKGROUND Tissue hardness is closely related to disease pathophysiology.Shear-wave ela-stography(SWE)is a simple and noninvasive ultrasound technique that has been used to evaluate the presence of lymph node metastas...BACKGROUND Tissue hardness is closely related to disease pathophysiology.Shear-wave ela-stography(SWE)is a simple and noninvasive ultrasound technique that has been used to evaluate the presence of lymph node metastases and differentiate between benign and malignant tumors.AIM To investigate SWE usefulness in measuring lymph node hardness to predict metastasis presence or absence in surgically removed lymph nodes.METHODS This observational study obtained data from patients who underwent surgery for esophageal or gastric cancer at Nippon Medical School Hospital.The hardness of the surgically removed lymph nodes was measured using SWE.The lymph nodes with hardness values≥2.2 m/s were considered clinically positive for metastasis,whereas those with lower hardness values were considered clinically negative.The lymph nodes subsequently underwent pathological examination to determine the presence of metastasis,and the SWE results and pathological assessments were compared.RESULTS A total of 1077 lymph nodes were evaluated;18 and 15 cases of esophageal and gastric cancer were identified,respectively.The optimal cutoff value for lymph node size was calculated to be 5.1 mm,and the area under the curve value was 0.74(95%confidence interval:0.69-0.84).When limited to a lymph node larger than the cut off value,the SWE sensitivity and specificity for metastasis identification were 0.76 and 0.82,respectively.CONCLUSION SWE was useful in detecting lymph node metastases in the upper gastrointestinal tract.展开更多
Lymph node dissection(lymphadenectomy)remains a critical component of pancreatic cancer surgery,contributing to accurate staging and guiding adjuvant therapy.The debate between standard and extended lymphadenectomy pe...Lymph node dissection(lymphadenectomy)remains a critical component of pancreatic cancer surgery,contributing to accurate staging and guiding adjuvant therapy.The debate between standard and extended lymphadenectomy persists,with evidence showing no significant survival advantage of extended dissection over the standard approach.Extended lymphadenectomy,while increasing the number of lymph nodes retrieved,is associated with longer operative times,greater blood loss,and higher morbidity.More importantly,lymph nodes serve as critical immune hubs,and excessive removal may compromise systemic immune surveillance,which is vital in the context of emerging immunotherapies for pan-creatic cancer.This minireview synthesizes the oncological and immunological perspectives on lymphadenectomy,advocating for a personalized approach to lymph node management in pancreatic cancer surgery,focusing on balancing oncologic outcomes with immune preservation.展开更多
BACKGROUND Lymph node metastasis(LNM)is a key prognostic factor in pancreatic cancer(PC).Accurate preoperative prediction of LNM remains challenging.Radiomics offers a noninvasive method to extract quantitative imagin...BACKGROUND Lymph node metastasis(LNM)is a key prognostic factor in pancreatic cancer(PC).Accurate preoperative prediction of LNM remains challenging.Radiomics offers a noninvasive method to extract quantitative imaging features that may aid in predicting LNM.AIM To investigate the potential value of a computed tomography(CT)-based radiomics model in prediction of LNM in PC.METHODS A retrospective analysis was performed on 168 pathologically confirmed PC patients who underwent contrast-enhanced-CT.Among them,107 cases had no LNM,while 61 cases had confirmed LNM.These patients were randomly divided into a training cohort(n=135)and a validation cohort(n=33).A total of 792 radiomics features were extracted,comprising 396 features from the arterial phase and another 396 from the portal venous phase.The Minimum Redundancy Maximum Relevance and Least Absolute Shrinkage and Selection Operator methods were used for feature selection and Radiomics model construction.The receiver operating characteristic curve was employed to assess the diagnostic potential of the model,and DeLong test was used to compare the area under the curve(AUC)values of the model.RESULTS Six radiomics features from the arterial phase and nine from the portal venous phase were selected.The Radscore model demonstrated strong predictive performance for LNM in both the training and test cohorts,with AUC values ranging from 0.86 to 0.94,sensitivity between 66.7% and 91.7%,specificity from 71.4% to 100.0%,accuracy between 78.8%and 91.1%,PPV ranging from 64.7% to 100.0%,and negative predictive value between 84.0% and 93.8%.No significant differences in AUC values were observed between the arterial and portal venous phases in either the training or test set.CONCLUSION The preoperative CT-based radiomics model exhibited robust predictive capability for identifying LNM in PC.展开更多
BACKGROUND Gastric schwannoma(GS)is often misdiagnosed as gastrointestinal stromal tumors due to the high incidence of the latter.However,these two types differ significantly in pathology and biological behavior.AIM T...BACKGROUND Gastric schwannoma(GS)is often misdiagnosed as gastrointestinal stromal tumors due to the high incidence of the latter.However,these two types differ significantly in pathology and biological behavior.AIM To evaluate the computed tomography characteristics of GS and provide insights into its accurate diagnosis.METHODS Twenty-three cases of GS confirmed between January 2011 and December 2023 were assessed clinically and radiologically.Imaging characteristics,including tumor location,size,contour,ulceration,growth pattern,enhancement degree and pattern,cystic change,calcification,and perigastric lymph nodes(PLNs),were reviewed by two experienced radiologists.RESULTS Our sample included 18 females and 5 males,with a median age of 54.7 years.A total of 39.1%of cases were asymptomatic.GSs appeared as oval and well-defined submucosal tumors,with exophytic(43.5%)or mixed(endoluminal+exophytic;43.5%)growth patterns.The tumors were primarily located in the gastric body(78.3%).Ulcerations were observed in 8 cases(34.5%),and PLNs were observed in 15 cases(65%).The average degree of enhancement was 48.3 Hounsfield units.Twenty cases(87%)showed peak enhancement in the delayed phase.Most GSs were homogeneous,while cystic change(13.0%)and calcification(17.4%)were rare.CONCLUSION GS predominantly showed gradual homogenous enhancement with peak enhancement in the delayed phase.PLNs around GS are helpful in differentiating GS from other gastric submucosal tumors.展开更多
BACKGROUND Gastric cancer(GC)is frequently diagnosed at advanced stages,often with lymph node metastasis(LNM),which complicates prognosis.Swollen LNM(SLNM)in GC has been linked to poor outcomes,yet its prognostic valu...BACKGROUND Gastric cancer(GC)is frequently diagnosed at advanced stages,often with lymph node metastasis(LNM),which complicates prognosis.Swollen LNM(SLNM)in GC has been linked to poor outcomes,yet its prognostic value requires validation.AIM To evaluate the prognostic significance of SLNM in GC patients undergoing curative-intent gastrectomy.METHODS A retrospective analysis included 507 GC patients with LNM,categorized by SLNM status into positive(SLNM present)and negative(SLNM absent)groups.Survival outcomes were compared between groups,including propensity score matching and multivariate analysis to assess the role of SLNM as an independent prognostic factor.RESULTS One hundred and thirty-nine(27.4%)patients exhibited SLNM,associated with significantly lower 5-year overall survival(OS)compared to non-SLNM patients(13.6%vs 35.8%,P<0.001).After matching,SLNM-positive patients maintained worse OS rates(13.4%vs 21.2%,P=0.006).Multivariate analysis confirmed SLNM as an independent prognostic factor(hazard ratio=1.318,P=0.031).Additionally,T4 stage,N3 stage,and neoadjuvant chemotherapy independently influenced survival outcomes for SLNM-positive patients.Those who received neoadjuvant chemotherapy demonstrated better prognosis.CONCLUSION SLNM is an independent predictor of poor prognosis in GC.Neoadjuvant chemotherapy followed by D2 gastrectomy and adjuvant chemotherapy may offer survival benefits for patients with SLNM.展开更多
BACKGROUND Dissection of the right paraesophageal lymph node(RPELN)in managing papillary thyroid carcinoma remains a contentious issue.This meta-analysis assesses previously established and novel risk factors associat...BACKGROUND Dissection of the right paraesophageal lymph node(RPELN)in managing papillary thyroid carcinoma remains a contentious issue.This meta-analysis assesses previously established and novel risk factors associated with RPELN metastasis.AIM To evaluate previously established and novel risk factors associated with RPELN metastasis in patients with papillary thyroid carcinoma papillary thyroid carcinoma through a comprehensive meta-analysis.METHODS We searched MEDLINE(via PubMed),ScienceDirect,Scopus and EMBASE up to December 2024.Studies were assessed using the Newcastle-Ottawa Scale.Statistical analysis was conducted with RevMan version 5.4,using the Q-test and I2-test for heterogeneity.Sensitivity was evaluated with the leave-one-out method,and publication bias with the Egger regression test and funnel plot.RESULTS Of 2444 articles retrieved,26 were included in our meta-analysis with 16427 patients.The RPELN metastasis rate was 12.98%[95%confidence interval(CI):12.46%-13.50%].The pooled results suggested that age<55 years[odds ratio(OR)=1.71,95%CI:1.35-2.16,P<0.00001],sex(OR=0.60,95%CI:0.54-0.67,P<0.00001),tumor size 1 cm(OR=3.37,95%CI:2.69-4.21,P<0.00001),multifocality(OR=1.81,95%CI:1.49-2.20,P<0.00001),capsular invasion(OR=2.94,95%CI:2.05-4.20,P<0.00001),vascular invasion(OR=2.16,95%CI:1.56-2.99,P<0.00001),extra-thyroid extension(OR=3.30,95%CI:1.82-5.98,P<0.0001),central lymph node metastasis(OR=7.77,95%CI:4.73-12.76,P<0.00001),lateral lymph node metastasis(OR=6.94,95%CI:6.11-7.89,P<0.00001),Hashimoto thyroiditis(OR=0.79,95%CI:0.69-0.92,P=0.002),micro-calcifications(OR=2.29,95%CI:1.20-4.37,P=0.01),and echogenicity(OR=0.62,95%CI:0.40-0.98,P=0.04)should be considered with RPELN metastasis.CONCLUSION The male<55,tumor size>1 cm,multifocality,capsular and vascular invasion,extrathyroidal extension,lymph node metastasis,and Hashimoto thyroiditis were significantly associated with RPELN metastasis and should be carefully assessed during dissection.展开更多
Euphorbia helioscopia,a natural plant recognized for its anti-tumor properties,has been extensively investigated in various cancers.However,its therapeutic potential in gastric cancer with positive lymph node metastas...Euphorbia helioscopia,a natural plant recognized for its anti-tumor properties,has been extensively investigated in various cancers.However,its therapeutic potential in gastric cancer with positive lymph node metastasis remains underexplored.This study aimed to elucidate the role of E.helioscopia in treating gastric cancer with lymph node metastasis using an integrative approach that combined network pharmacology,molecular docking,and molecular dynamics simulations.Initially,shared target data between E.helioscopia and gastric cancer with positive lymph node metastasis were identified and systematically analyzed.Subsequently,molecular docking was conducted to validate the interactions between key components and targets.Finally,molecular dynamics simulations were employed,with binding free energy calculations performed using the MM-PBSA algorithm.The findings revealed that the primary bioactive compounds of E.helioscopia in this context included quercetin and luteolin,targeting core molecules such as EGFR and MMP9.Key pathways implicated in its mechanism of action included resistance to EGFR tyrosine kinase inhibitors,among others.Molecular docking demonstrated robust binding affinity between the active compounds and critical targets,with molecular dynamics and binding free energy analyses highlighting a particularly stable interaction between luteolin and MMP9.In conclusion,E.helioscopia exhibited a multi-component,multi-target,and multi-pathway therapeutic profile in treating gastric cancer with positive lymph node metastasis.These findings offered valuable theoretical insights supporting its potential clinical application in oncology.展开更多
Background: Sentinel lymph node (SLN) biopsy remains a cornerstone in the management of breast cancer, as it provides an accurate staging of the disease while minimizing the morbidity associated with complete axillary...Background: Sentinel lymph node (SLN) biopsy remains a cornerstone in the management of breast cancer, as it provides an accurate staging of the disease while minimizing the morbidity associated with complete axillary lymph node dissection. Advances in SLN detection have been very important in refining surgical techniques and improving patient outcomes. The purpose of the present study is to compare the effectiveness of radiocolloids, blue dyes, and fluorescent tracers in detecting the sentinel lymph node in breast cancer. Materials and Methods: Specifically, we analyzed the detection rate, accuracy, and safety profile of the techniques to outline the most reliable and clinically available. A comprehensive review was conducted, searching key databases, including PubMed, Scopus, and Web of Science, for studies published between 2010 and 2024. The review focused on studies that compared the performance of radiocolloids, blue dyes, and fluorescent tracers in the detection of sentinel lymph nodes in breast cancer patients. A total of 54 studies were included based on specific inclusion criteria. Results: Radiocolloids showed high detection rates in studies. Blue dyes have comparable results, but a small percentage of allergic reactions has been observed. Fluorescent tracers such as indocyanine green have improved visualization and accuracy, but their use requires specialized equipment and expertise. Combining radiocolloids with blue dyes or fluorescent tracers has improved detection rates in several studies. Cost and accessibility challenges have also been pointed out, particularly in low-resource settings. Conclusions: Radiocolloids have attained the status of gold standard in the detection of SLNs in breast cancer for their reliability and accuracy. While combined use with other tracers, like blue dyes or fluorescent agents, enhances overall detection performance, making it more holistic. As expected, further innovation and effort are required to improve accessibility and optimize the technique of sentinel lymph node biopsy worldwide.展开更多
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
BACKGROUND Gastrointestinal dual-contrast ultrasonography(DCUS)is characterized by its high resolution,sensitivity,and specificity.AIM To determine the accuracy of DCUS in predicting lymph node metastasis in middle-ag...BACKGROUND Gastrointestinal dual-contrast ultrasonography(DCUS)is characterized by its high resolution,sensitivity,and specificity.AIM To determine the accuracy of DCUS in predicting lymph node metastasis in middle-aged and elderly patients with gastric cancer(GC).METHODS A total of 100 middle-aged and elderly patients with GC admitted to the Fourth Affiliated Hospital of Soochow University(Dushu Lake Hospital,Suzhou,China)between April 2022 and April 2024 were selected.The baseline data and lymph node metastasis status were collected.DCUS combined with intravenous contrast technology was used to calculate the enhancement time(ET),time to peak(TTP),and slope of the ascending branch wash-in rate(WIR).These indicators were used in assessing lymph node metastasis in patients with GC.RESULTS Among 100 middle-aged and elderly patients with GC,35(35.00%)had lymph node metastases.GC patients with lymph node metastasis had a higher propor-tion of stage II TNM classification and higher WIR values than those without lymph node metastasis.The ET and TTP values were lower in patients with lymph node metastases,and all differences were statistically significant(P<0.05).The area under the curve values for ET,TTP,WIR,and combined diagnosis of GC lymph node metastasis using DCUS were all>0.7.Optimal assessment was achieved when the cutoff values for ET,TTP,and WIR were set at 16.32 seconds,10.67 seconds,and 7.02,res-pectively.CONCLUSION DCUS-mediated assessment of ET,TTP,and WIR can effectively predict and evaluate lymph node metastasis status in patients with GC,with higher sensitivity when used in combination.展开更多
Most papillary thyroid carcinoma(PTC) patients have a good prognosis. However, lymph node metastasis(LNM), the most common manifestation of disease progression, is frequently associated with a poor prognosis.Neverthel...Most papillary thyroid carcinoma(PTC) patients have a good prognosis. However, lymph node metastasis(LNM), the most common manifestation of disease progression, is frequently associated with a poor prognosis.Nevertheless, few studies have focused on the underlying mechanisms of LNM. In the current study, we aimed to investigate the potential role of exosomal circRNAs that contribute to LNM in PTC. We identified 9 000 differentially expressed exosomal circRNAs in PTC patients with LNM, including 684 upregulated and 2 193 downregulated circRNAs. Functional enrichment analysis revealed that these differentially expressed circRNAs were primarily involved in a variety of molecular and signaling pathways correlated with PTC progression and LNM. Through bioinformatics analysis, we identified 14 circRNA-miRNA-mRNA networks related to LNM-associated signaling pathways in PTC. Moreover, both circTACC2-miR-7-EGFR and circBIRC6-miR-24-3p-BCL2L11 axes were verified for their potential involvement in PTC with LNM. Additionally, we identified four upregulated circRNA-related hub genes and eight hub genes correlated with downregulated circRNAs, some of which were validated as being potentially involved in LNM in PTC. Collectively, our findings provide a novel framework for an in-depth investigation of the function of dysregulated exosomal circRNAs and their potential as biomarkers in PTC patients with LNM.展开更多
BACKGROUND Accumulating studies indicated that maintain nuclei homeostasis was deemed to the protective factors for the occurrence of cancer.Thus,high-mobility group box 1(HMGB1)might influence the risk and poorer pro...BACKGROUND Accumulating studies indicated that maintain nuclei homeostasis was deemed to the protective factors for the occurrence of cancer.Thus,high-mobility group box 1(HMGB1)might influence the risk and poorer prognoses of colorectal cancer(CRC).AIM This study was designed to investigate whether HMGB1 polymorphisms influence the risk and lymph node metastasis(LNM)of CRC.METHODS Firstly,we designed an investigation with 1003 CRC patients and 1303 cancer-free controls to observe whether HMGB1 rs1412125 T>C and rs1045411 C>T SNPs could influence the risk of cancer.Subsequently,we carried out a correlation-analysis to assess whether these SNPs could alter the risk of LNM.RESULTS The current investigation suggested a relationship of HMGB1 rs1412125 SNP with the increased susceptibility of CRC.In a subgroup analysis,our findings suggested that this SNP could enhance an occurrence of CRC in≥61 years,non-drinker and body mass index<24 kg/m2 subgroups.However,we found that there was null association between HMGB1 rs1412125 SNP and LNM,even in different CRC region.These observations were confirmed by calculating the power value(more than 0.8).The association of HMGB1 rs1045411 C>T SNP with CRC risk and LNM was not found in any compare.CONCLUSION This study highlights a possible association between HMGB1 rs1412125 polymorphism and the increased risk of CRC.In the future,more studies should be conducted to explore HMGB1 rs1412125 polymorphism in relation to CRC development.展开更多
BACKGROUND Gastric cancer(GC)poses a significant threat to public health.However,the clinicopathological features and tumor biological behaviors vary among the GC patients,leading to individual variations in lymph nod...BACKGROUND Gastric cancer(GC)poses a significant threat to public health.However,the clinicopathological features and tumor biological behaviors vary among the GC patients,leading to individual variations in lymph node metastasis.Consequently,the stratification of lymph node dissection according to the specific type,particularly upper GC,has emerged as a prominent area of research.AIM To investigate the distribution of metastatic lymph nodes in patients with upper and lower GC and to analyze the differences in related pathological elements and prognosis.METHODS Differential analysis between upper and lower GC patients with various clinicopathological factors was performed using the chi-square test and rank-sum regression models were used to analyze risk factors affecting patient prognosis.The Kaplan-Meier method was used to construct survival curves associated with prognostic risk factors for GC.RESULTS Significant differences were observed between the two GC populations regarding tumor diameter,histological grade,pT stage,pN stage,tumor-node-metastasis(pTNM)stage,vascular invasion,and adjuvant chemotherapy usage(all P<0.05).Lymph node metastasis rates were highest for Siewert type II patients in groups Nos.1,3,2 and 7;for Siewert type III patients in groups Nos.3,1,2 and 7;and for other/unclassified patients in groups Nos.1,3,7,2.In the lower GC samples,the sequences were Nos.3,6,7,4.Pathological type,pT stage,pTNM stage,and positive vascular invasion were independent risk factors for development of lymph node metastasis.Age,pathological type,pT stage,pN stage,pTNM stage,vascular invasion,and absence of adjuvant chemotherapy were identified as independent prognostic factors.CONCLUSION Upper GC showed a significantly higher malignancy grade and different lymph node metastasis pattern than lower GC.展开更多
基金supported by grants from the National Natural Science Foundation of China(Grant Nos.81672638 and W2421095)National Natural Science Foundation of Shandong Province(Grant No.ZR2024LMB011)Collaborative Academic Innovation Project of Shandong Cancer Hospital(Grant No.GF003)。
文摘The principal breast cancer treatment approach has long been surgical removal of the primary breast lesions and regional lymph nodes,particularly the axillary lymph nodes.However,the advent of minimally invasive diagnostic techniques,such as sentinel lymph node biopsy(SLNB),has markedly diminished the extent of surgery required for regional lymph nodes.
基金the Clinical Medical Team Introduction Program of Suzhou,No.SZYJTD201804.
文摘BACKGROUND Lymph node status is a critical prognostic factor in gastric cancer(GC),but stage migration may occur in pathological lymph nodes(pN)staging.To address this,alternative staging systems such as the positive lymph node ratio(LNR)and log odds of positive lymph nodes(LODDS)were introduced.AIM To assess the prognostic accuracy and stratification efficacy of three nodal staging systems in GC.METHODS A systematic review identified 12 studies,from which hazard ratios(HRs)for overall survival(OS)were summarized.Sensitivity analyses,subgroup analyses,publication bias assessments,and quality evaluations were conducted.To enhance comparability,data from studies with identical cutoff values for pN,LNR,and LODDS were pooled.Homogeneous stratification was then applied to generate Kaplan-Meier(KM)survival curves,assessing the stratification efficacy of three staging systems.RESULTS The HRs and 95%confidence intervals for pN,LNR,and LODDS were 2.16(1.72-2.73),2.05(1.65-2.55),and 3.15(2.15-4.37),respectively,confirming all three as independent prognostic risk factors for OS.Comparative analysis of HRs demonstrated that LODDS had superior prognostic predictive power over LNR and pN.KM curves for pN(N0,N1,N2,N3a,N3b),LNR(0.1/0.2/0.5),and LODDS(-1.5/-1.0/-0.5/0)revealed significant differences(P<0.001)among all prognostic stratifications.Mean differences and standard deviations in 60-month relative survival were 27.93%±0.29%,41.70%±0.30%,and 26.60%±0.28%for pN,LNR,and LODDS,respectively.CONCLUSION All three staging systems are independent prognostic factors for OS.LODDS demonstrated the highest specificity,making it especially useful for predicting outcomes,while pN was the most effective in homogeneous stratification,offering better patient differentiation.These findings highlight the complementary roles of LODDS and pN in enhancing prognostic accuracy and stratification.
文摘Introduction The accuracy of sentinel lymph node biopsy(SLNB)after neoadjuvant therapy(NAT)has been confirmed in clinical nodal stage 1(c N1)patients,and more patients could benefit from axillary surgery de-escalation after NAT(1,2).
基金supported by the Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors(Fujian Medical University)and Clinical Research Center for Radiology and Radiotherapy of Fujian Province(Digestive,Hematological and Breast Malignancies).
文摘Background:Metastasis to the infraclavicular and supraclavicular lymph nodes(ISLNs)is an important factor that predicts poor survival in patients with breast cancer;however,pathological nodal staging does not traditionally include ISLNs because of their non-routine surgical dissection.This study aimed to evaluate the prognostic impact of ISLN metastasis and propose a refined nodal staging system tailored for patients undergoing neoadjuvant chemotherapy(NAC).Methods:We retrospectively reviewed 1,072 patients with breast cancer with or without ISLN metastasis who received NAC at two institutions(Fujian cohort and Hebei cohort)from 2010 to 2022.We conducted detailed survival analysis to evaluate the diagnostic consistency and prognostic significance of ISLNs.Results:There were no survival differences among patients with ISLN involvement across different assay method-ologies and patient cohorts.Among 887 patients in the Fujian cohort,238 patients(26.8%)with positive ISLNs had significantly inferior 3-year progression-free survival(PFS,75.9%vs.90.4%,P<0.001)and overall survival(OS,90.6%vs.95.9%,P<0.001).After adjusting for potential confounders,ISLN involvement persisted as an independent predictor of both PFS and OS.We propose a refined axillary classification that combines pathologi-cal axillary staging post-NAC with ISLN involvement,revealing 3-year PFS rates of 95.3%,87.6%,73.4%,and 64.5%for the respective four groups defined by this refined classification combining axillary stage and ISLN status.Conclusions:Involvement of the ISLNs was associated with a worse prognosis,underscoring their prognostic value.This finding highlights the potential of ISLN status to influence decisions regarding adjuvant treatment in patients with breast cancer.
文摘BACKGROUND One of the main characteristics of oral squamous cell carcinoma(OSCC)is that it metastasizes to cervical lymph nodes frequently with a high degree of local invasiveness.A primary feature of malignant tumors is their penetration of neighboring tissues,such as lymphatic and blood arteries,due to the tumor cells'capacity to break down the extracellular matrix(ECM).Matrix metalloproteinases(MMPs)constitute a family of proteolytic enzymes that facilitate tissue remodeling and the degradation of the ECM.MMP-9 and MMP-13 belong to the group of extracellular matrix degrading enzymes and their expression has been studied in OSCC because of their specific functions.MMP-13,a collagenase family member,is thought to play an essential role in the MMP activation cascade by breaking down the fibrillar collagens,whereas MMP-9 is thought to accelerate the growth of tumors.Elevated MMP-13 expression has been associated with tumor behavior and patient prognosis in a number of malignant cases.AIM To assess the immunohistochemical expression of MMP-9 and MMP-13 in OSCC.METHODS A total of 40 cases with histologically confirmed OSCC by incisional biopsy were included in this cross-sectional retrospective study.The protocols for both MMP-9 and MMP-13 immunohistochemical staining were performed according to the manufacturer’s recommendations along with the normal gingival epithelium as a positive control.All the observations were recorded and Pearson’sχ²test with Fisher exact test was used for statistical analysis.RESULTS Our study showed no significant correlation between MMP-9 and MMP-13 staining intensity and tumor size.The majority of the patients were in advanced TNM stages(III and IV),and showed intense expression of MMP-9 and MMP-13.CONCLUSION The present study suggests that both MMP-9 and MMP-13 play an important and independent role in OSCC progression and invasiveness.Intense expression of MMP-9 and MMP-13,irrespective of histological grade of OSCC,correlates well with TNM stage.Consequently,it is evident that MMP-9 and MMP-13 are important for the invasiveness and progression of tumors.The findings may facilitate the development of new approaches for evaluating lymph node metastases and interventional therapy techniques,hence enhancing the prognosis of patients diagnosed with OSCC.
基金Supported by Clinical Trials from the Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,No.2021-LCYJ-MS-11Nanjing Drum Tower Hospital National Natural Science Foundation Youth Cultivation Project,No.2024-JCYJQP-15.
文摘Imaging evaluation of lymph node metastasis and infiltration faces problems such as low artificial outline efficiency and insufficient consistency.Deep learning technology based on convolutional neural networks has greatly improved the technical effect of radiomics in lymph node pathological characteristics analysis and efficacy monitoring through automatic lymph node detection,precise segmentation and three-dimensional reconstruction algorithms.This review focuses on the automatic lymph node segmentation model,treatment response prediction algorithm and benign and malignant differential diagnosis system for multimodal imaging,in order to provide a basis for further research on artificial intelligence to assist lymph node disease management and clinical decision-making,and provide a reference for promoting the construction of a system for accurate diagnosis,personalized treatment and prognostic evaluation of lymph node-related diseases.
文摘Accurate preoperative prediction of lymph node metastasis is crucial for developing clinical management strategies for patients with esophageal cancer.In this letter,we present our insights and opinions on a new nomogram proposed by Xu et al.Although this research has great potential,there are still concerns re-garding the small sample size,limited consideration of biological complexity,subjective image segmentation,incomplete image feature extraction and statistical analyses.Furthermore,we discuss how to achieve more robust and accurate predictive performance in future research.
基金This study was approved by the Ethics Committee of Nippon Medical School Hospital(No.B-2022-582).
文摘BACKGROUND Tissue hardness is closely related to disease pathophysiology.Shear-wave ela-stography(SWE)is a simple and noninvasive ultrasound technique that has been used to evaluate the presence of lymph node metastases and differentiate between benign and malignant tumors.AIM To investigate SWE usefulness in measuring lymph node hardness to predict metastasis presence or absence in surgically removed lymph nodes.METHODS This observational study obtained data from patients who underwent surgery for esophageal or gastric cancer at Nippon Medical School Hospital.The hardness of the surgically removed lymph nodes was measured using SWE.The lymph nodes with hardness values≥2.2 m/s were considered clinically positive for metastasis,whereas those with lower hardness values were considered clinically negative.The lymph nodes subsequently underwent pathological examination to determine the presence of metastasis,and the SWE results and pathological assessments were compared.RESULTS A total of 1077 lymph nodes were evaluated;18 and 15 cases of esophageal and gastric cancer were identified,respectively.The optimal cutoff value for lymph node size was calculated to be 5.1 mm,and the area under the curve value was 0.74(95%confidence interval:0.69-0.84).When limited to a lymph node larger than the cut off value,the SWE sensitivity and specificity for metastasis identification were 0.76 and 0.82,respectively.CONCLUSION SWE was useful in detecting lymph node metastases in the upper gastrointestinal tract.
文摘Lymph node dissection(lymphadenectomy)remains a critical component of pancreatic cancer surgery,contributing to accurate staging and guiding adjuvant therapy.The debate between standard and extended lymphadenectomy persists,with evidence showing no significant survival advantage of extended dissection over the standard approach.Extended lymphadenectomy,while increasing the number of lymph nodes retrieved,is associated with longer operative times,greater blood loss,and higher morbidity.More importantly,lymph nodes serve as critical immune hubs,and excessive removal may compromise systemic immune surveillance,which is vital in the context of emerging immunotherapies for pan-creatic cancer.This minireview synthesizes the oncological and immunological perspectives on lymphadenectomy,advocating for a personalized approach to lymph node management in pancreatic cancer surgery,focusing on balancing oncologic outcomes with immune preservation.
基金Supported by National Natural Science foundation of China,No.82202135,No.82371919,No.82372017,and No.82171925China Postdoctoral Science Foundation,No.2023M741808+4 种基金Young Elite Scientists Sponsorship Program by China Association of Chinese Medicine,No.2024-QNRC2-B16Jiangsu Provincial Key Research and Development Program,No.BE2023789Young Elite Scientists Sponsorship Program by Jiangsu Association for Science and Technology,No.JSTJ-2023-WJ027Project funded by Nanjing Postdoctoral Science Foundation,Natural Science Foundation of Nanjing University of Chinese Medicine,No.XZR2023036Foundation of Excellent Young Doctor of Jiangsu Province Hospital of Chinese Medicine,No.2023QB0112.
文摘BACKGROUND Lymph node metastasis(LNM)is a key prognostic factor in pancreatic cancer(PC).Accurate preoperative prediction of LNM remains challenging.Radiomics offers a noninvasive method to extract quantitative imaging features that may aid in predicting LNM.AIM To investigate the potential value of a computed tomography(CT)-based radiomics model in prediction of LNM in PC.METHODS A retrospective analysis was performed on 168 pathologically confirmed PC patients who underwent contrast-enhanced-CT.Among them,107 cases had no LNM,while 61 cases had confirmed LNM.These patients were randomly divided into a training cohort(n=135)and a validation cohort(n=33).A total of 792 radiomics features were extracted,comprising 396 features from the arterial phase and another 396 from the portal venous phase.The Minimum Redundancy Maximum Relevance and Least Absolute Shrinkage and Selection Operator methods were used for feature selection and Radiomics model construction.The receiver operating characteristic curve was employed to assess the diagnostic potential of the model,and DeLong test was used to compare the area under the curve(AUC)values of the model.RESULTS Six radiomics features from the arterial phase and nine from the portal venous phase were selected.The Radscore model demonstrated strong predictive performance for LNM in both the training and test cohorts,with AUC values ranging from 0.86 to 0.94,sensitivity between 66.7% and 91.7%,specificity from 71.4% to 100.0%,accuracy between 78.8%and 91.1%,PPV ranging from 64.7% to 100.0%,and negative predictive value between 84.0% and 93.8%.No significant differences in AUC values were observed between the arterial and portal venous phases in either the training or test set.CONCLUSION The preoperative CT-based radiomics model exhibited robust predictive capability for identifying LNM in PC.
基金Supported by the National Natural Science Foundation of China,No.82101985.
文摘BACKGROUND Gastric schwannoma(GS)is often misdiagnosed as gastrointestinal stromal tumors due to the high incidence of the latter.However,these two types differ significantly in pathology and biological behavior.AIM To evaluate the computed tomography characteristics of GS and provide insights into its accurate diagnosis.METHODS Twenty-three cases of GS confirmed between January 2011 and December 2023 were assessed clinically and radiologically.Imaging characteristics,including tumor location,size,contour,ulceration,growth pattern,enhancement degree and pattern,cystic change,calcification,and perigastric lymph nodes(PLNs),were reviewed by two experienced radiologists.RESULTS Our sample included 18 females and 5 males,with a median age of 54.7 years.A total of 39.1%of cases were asymptomatic.GSs appeared as oval and well-defined submucosal tumors,with exophytic(43.5%)or mixed(endoluminal+exophytic;43.5%)growth patterns.The tumors were primarily located in the gastric body(78.3%).Ulcerations were observed in 8 cases(34.5%),and PLNs were observed in 15 cases(65%).The average degree of enhancement was 48.3 Hounsfield units.Twenty cases(87%)showed peak enhancement in the delayed phase.Most GSs were homogeneous,while cystic change(13.0%)and calcification(17.4%)were rare.CONCLUSION GS predominantly showed gradual homogenous enhancement with peak enhancement in the delayed phase.PLNs around GS are helpful in differentiating GS from other gastric submucosal tumors.
基金Supported by The Shandong Provincial Medical and Health Science and Technology Youth Project,China,No.202304081355The Weifang Youth Medical Talent Lift Project,Chinaand The Science and Technology Development Project of Affiliated Hospital of Shandong Second Medical University,China,No.2023FYQ004.
文摘BACKGROUND Gastric cancer(GC)is frequently diagnosed at advanced stages,often with lymph node metastasis(LNM),which complicates prognosis.Swollen LNM(SLNM)in GC has been linked to poor outcomes,yet its prognostic value requires validation.AIM To evaluate the prognostic significance of SLNM in GC patients undergoing curative-intent gastrectomy.METHODS A retrospective analysis included 507 GC patients with LNM,categorized by SLNM status into positive(SLNM present)and negative(SLNM absent)groups.Survival outcomes were compared between groups,including propensity score matching and multivariate analysis to assess the role of SLNM as an independent prognostic factor.RESULTS One hundred and thirty-nine(27.4%)patients exhibited SLNM,associated with significantly lower 5-year overall survival(OS)compared to non-SLNM patients(13.6%vs 35.8%,P<0.001).After matching,SLNM-positive patients maintained worse OS rates(13.4%vs 21.2%,P=0.006).Multivariate analysis confirmed SLNM as an independent prognostic factor(hazard ratio=1.318,P=0.031).Additionally,T4 stage,N3 stage,and neoadjuvant chemotherapy independently influenced survival outcomes for SLNM-positive patients.Those who received neoadjuvant chemotherapy demonstrated better prognosis.CONCLUSION SLNM is an independent predictor of poor prognosis in GC.Neoadjuvant chemotherapy followed by D2 gastrectomy and adjuvant chemotherapy may offer survival benefits for patients with SLNM.
文摘BACKGROUND Dissection of the right paraesophageal lymph node(RPELN)in managing papillary thyroid carcinoma remains a contentious issue.This meta-analysis assesses previously established and novel risk factors associated with RPELN metastasis.AIM To evaluate previously established and novel risk factors associated with RPELN metastasis in patients with papillary thyroid carcinoma papillary thyroid carcinoma through a comprehensive meta-analysis.METHODS We searched MEDLINE(via PubMed),ScienceDirect,Scopus and EMBASE up to December 2024.Studies were assessed using the Newcastle-Ottawa Scale.Statistical analysis was conducted with RevMan version 5.4,using the Q-test and I2-test for heterogeneity.Sensitivity was evaluated with the leave-one-out method,and publication bias with the Egger regression test and funnel plot.RESULTS Of 2444 articles retrieved,26 were included in our meta-analysis with 16427 patients.The RPELN metastasis rate was 12.98%[95%confidence interval(CI):12.46%-13.50%].The pooled results suggested that age<55 years[odds ratio(OR)=1.71,95%CI:1.35-2.16,P<0.00001],sex(OR=0.60,95%CI:0.54-0.67,P<0.00001),tumor size 1 cm(OR=3.37,95%CI:2.69-4.21,P<0.00001),multifocality(OR=1.81,95%CI:1.49-2.20,P<0.00001),capsular invasion(OR=2.94,95%CI:2.05-4.20,P<0.00001),vascular invasion(OR=2.16,95%CI:1.56-2.99,P<0.00001),extra-thyroid extension(OR=3.30,95%CI:1.82-5.98,P<0.0001),central lymph node metastasis(OR=7.77,95%CI:4.73-12.76,P<0.00001),lateral lymph node metastasis(OR=6.94,95%CI:6.11-7.89,P<0.00001),Hashimoto thyroiditis(OR=0.79,95%CI:0.69-0.92,P=0.002),micro-calcifications(OR=2.29,95%CI:1.20-4.37,P=0.01),and echogenicity(OR=0.62,95%CI:0.40-0.98,P=0.04)should be considered with RPELN metastasis.CONCLUSION The male<55,tumor size>1 cm,multifocality,capsular and vascular invasion,extrathyroidal extension,lymph node metastasis,and Hashimoto thyroiditis were significantly associated with RPELN metastasis and should be carefully assessed during dissection.
基金The Gansu Province University Industrial Support Plan(Grant No.2023CYZC-05)the Cuiying Technology Innovation Project of Lanzhou University Second Hospital(Grant No.CY2022-MS-B04)+1 种基金the Doctoral Students Training Research Fund of Lanzhou University Second Hospital(Grant No.YJS-BD-32)the Gansu Province Drug Regulatory Science Research Project in 2024(Grant No.2024GSMPA032).
文摘Euphorbia helioscopia,a natural plant recognized for its anti-tumor properties,has been extensively investigated in various cancers.However,its therapeutic potential in gastric cancer with positive lymph node metastasis remains underexplored.This study aimed to elucidate the role of E.helioscopia in treating gastric cancer with lymph node metastasis using an integrative approach that combined network pharmacology,molecular docking,and molecular dynamics simulations.Initially,shared target data between E.helioscopia and gastric cancer with positive lymph node metastasis were identified and systematically analyzed.Subsequently,molecular docking was conducted to validate the interactions between key components and targets.Finally,molecular dynamics simulations were employed,with binding free energy calculations performed using the MM-PBSA algorithm.The findings revealed that the primary bioactive compounds of E.helioscopia in this context included quercetin and luteolin,targeting core molecules such as EGFR and MMP9.Key pathways implicated in its mechanism of action included resistance to EGFR tyrosine kinase inhibitors,among others.Molecular docking demonstrated robust binding affinity between the active compounds and critical targets,with molecular dynamics and binding free energy analyses highlighting a particularly stable interaction between luteolin and MMP9.In conclusion,E.helioscopia exhibited a multi-component,multi-target,and multi-pathway therapeutic profile in treating gastric cancer with positive lymph node metastasis.These findings offered valuable theoretical insights supporting its potential clinical application in oncology.
文摘Background: Sentinel lymph node (SLN) biopsy remains a cornerstone in the management of breast cancer, as it provides an accurate staging of the disease while minimizing the morbidity associated with complete axillary lymph node dissection. Advances in SLN detection have been very important in refining surgical techniques and improving patient outcomes. The purpose of the present study is to compare the effectiveness of radiocolloids, blue dyes, and fluorescent tracers in detecting the sentinel lymph node in breast cancer. Materials and Methods: Specifically, we analyzed the detection rate, accuracy, and safety profile of the techniques to outline the most reliable and clinically available. A comprehensive review was conducted, searching key databases, including PubMed, Scopus, and Web of Science, for studies published between 2010 and 2024. The review focused on studies that compared the performance of radiocolloids, blue dyes, and fluorescent tracers in the detection of sentinel lymph nodes in breast cancer patients. A total of 54 studies were included based on specific inclusion criteria. Results: Radiocolloids showed high detection rates in studies. Blue dyes have comparable results, but a small percentage of allergic reactions has been observed. Fluorescent tracers such as indocyanine green have improved visualization and accuracy, but their use requires specialized equipment and expertise. Combining radiocolloids with blue dyes or fluorescent tracers has improved detection rates in several studies. Cost and accessibility challenges have also been pointed out, particularly in low-resource settings. Conclusions: Radiocolloids have attained the status of gold standard in the detection of SLNs in breast cancer for their reliability and accuracy. While combined use with other tracers, like blue dyes or fluorescent agents, enhances overall detection performance, making it more holistic. As expected, further innovation and effort are required to improve accessibility and optimize the technique of sentinel lymph node biopsy worldwide.
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.
文摘BACKGROUND Gastrointestinal dual-contrast ultrasonography(DCUS)is characterized by its high resolution,sensitivity,and specificity.AIM To determine the accuracy of DCUS in predicting lymph node metastasis in middle-aged and elderly patients with gastric cancer(GC).METHODS A total of 100 middle-aged and elderly patients with GC admitted to the Fourth Affiliated Hospital of Soochow University(Dushu Lake Hospital,Suzhou,China)between April 2022 and April 2024 were selected.The baseline data and lymph node metastasis status were collected.DCUS combined with intravenous contrast technology was used to calculate the enhancement time(ET),time to peak(TTP),and slope of the ascending branch wash-in rate(WIR).These indicators were used in assessing lymph node metastasis in patients with GC.RESULTS Among 100 middle-aged and elderly patients with GC,35(35.00%)had lymph node metastases.GC patients with lymph node metastasis had a higher propor-tion of stage II TNM classification and higher WIR values than those without lymph node metastasis.The ET and TTP values were lower in patients with lymph node metastases,and all differences were statistically significant(P<0.05).The area under the curve values for ET,TTP,WIR,and combined diagnosis of GC lymph node metastasis using DCUS were all>0.7.Optimal assessment was achieved when the cutoff values for ET,TTP,and WIR were set at 16.32 seconds,10.67 seconds,and 7.02,res-pectively.CONCLUSION DCUS-mediated assessment of ET,TTP,and WIR can effectively predict and evaluate lymph node metastasis status in patients with GC,with higher sensitivity when used in combination.
基金National Natural Science Foundation of China (Grant No. 81800698)Jiangsu Provincial Medical Key Discipline Cultivation Unit (Grant No. JSDW202241)+1 种基金Research Project of Jiangsu Commission of Health (Grant No. H2023053)Zhenjiang Science and the Technology Planning Project (Grant Nos. SH2023006and SH2023008)。
文摘Most papillary thyroid carcinoma(PTC) patients have a good prognosis. However, lymph node metastasis(LNM), the most common manifestation of disease progression, is frequently associated with a poor prognosis.Nevertheless, few studies have focused on the underlying mechanisms of LNM. In the current study, we aimed to investigate the potential role of exosomal circRNAs that contribute to LNM in PTC. We identified 9 000 differentially expressed exosomal circRNAs in PTC patients with LNM, including 684 upregulated and 2 193 downregulated circRNAs. Functional enrichment analysis revealed that these differentially expressed circRNAs were primarily involved in a variety of molecular and signaling pathways correlated with PTC progression and LNM. Through bioinformatics analysis, we identified 14 circRNA-miRNA-mRNA networks related to LNM-associated signaling pathways in PTC. Moreover, both circTACC2-miR-7-EGFR and circBIRC6-miR-24-3p-BCL2L11 axes were verified for their potential involvement in PTC with LNM. Additionally, we identified four upregulated circRNA-related hub genes and eight hub genes correlated with downregulated circRNAs, some of which were validated as being potentially involved in LNM in PTC. Collectively, our findings provide a novel framework for an in-depth investigation of the function of dysregulated exosomal circRNAs and their potential as biomarkers in PTC patients with LNM.
基金Supported by the Major Project of Changzhou Science and Technology Bureau,No.CJ20220255.
文摘BACKGROUND Accumulating studies indicated that maintain nuclei homeostasis was deemed to the protective factors for the occurrence of cancer.Thus,high-mobility group box 1(HMGB1)might influence the risk and poorer prognoses of colorectal cancer(CRC).AIM This study was designed to investigate whether HMGB1 polymorphisms influence the risk and lymph node metastasis(LNM)of CRC.METHODS Firstly,we designed an investigation with 1003 CRC patients and 1303 cancer-free controls to observe whether HMGB1 rs1412125 T>C and rs1045411 C>T SNPs could influence the risk of cancer.Subsequently,we carried out a correlation-analysis to assess whether these SNPs could alter the risk of LNM.RESULTS The current investigation suggested a relationship of HMGB1 rs1412125 SNP with the increased susceptibility of CRC.In a subgroup analysis,our findings suggested that this SNP could enhance an occurrence of CRC in≥61 years,non-drinker and body mass index<24 kg/m2 subgroups.However,we found that there was null association between HMGB1 rs1412125 SNP and LNM,even in different CRC region.These observations were confirmed by calculating the power value(more than 0.8).The association of HMGB1 rs1045411 C>T SNP with CRC risk and LNM was not found in any compare.CONCLUSION This study highlights a possible association between HMGB1 rs1412125 polymorphism and the increased risk of CRC.In the future,more studies should be conducted to explore HMGB1 rs1412125 polymorphism in relation to CRC development.
文摘BACKGROUND Gastric cancer(GC)poses a significant threat to public health.However,the clinicopathological features and tumor biological behaviors vary among the GC patients,leading to individual variations in lymph node metastasis.Consequently,the stratification of lymph node dissection according to the specific type,particularly upper GC,has emerged as a prominent area of research.AIM To investigate the distribution of metastatic lymph nodes in patients with upper and lower GC and to analyze the differences in related pathological elements and prognosis.METHODS Differential analysis between upper and lower GC patients with various clinicopathological factors was performed using the chi-square test and rank-sum regression models were used to analyze risk factors affecting patient prognosis.The Kaplan-Meier method was used to construct survival curves associated with prognostic risk factors for GC.RESULTS Significant differences were observed between the two GC populations regarding tumor diameter,histological grade,pT stage,pN stage,tumor-node-metastasis(pTNM)stage,vascular invasion,and adjuvant chemotherapy usage(all P<0.05).Lymph node metastasis rates were highest for Siewert type II patients in groups Nos.1,3,2 and 7;for Siewert type III patients in groups Nos.3,1,2 and 7;and for other/unclassified patients in groups Nos.1,3,7,2.In the lower GC samples,the sequences were Nos.3,6,7,4.Pathological type,pT stage,pTNM stage,and positive vascular invasion were independent risk factors for development of lymph node metastasis.Age,pathological type,pT stage,pN stage,pTNM stage,vascular invasion,and absence of adjuvant chemotherapy were identified as independent prognostic factors.CONCLUSION Upper GC showed a significantly higher malignancy grade and different lymph node metastasis pattern than lower GC.
