A case of lung cancer with hyperthyroidism]

We here report a case of metastasis from lung cancer to the thyroid. On presentation, this patient showed painful anterior cervical swelling and right supraclavicular lymph node swelling. Laboratory data showed primary hyperthyroidism. Although subacute thyroiditis was suspected, echo-guided needle aspiration biopsy and lymph node biopsy revealed poorly differentiated squamous cell carcinoma. As a result, primary lung cancer with thyroid metastasis was diagnosed based on mediastinal enlargement on chest X ray films and normal findings in organs other than the lung and thyroid. Chemotherapy for lung cancer induced a decrease in the size of tumor and the normalization of thyroid function. However, 2 months after the normalization, cervical swelling enlarged and a lung mass in right upper lobe and skin tumor appeared. Despite treatment with chemotherapy, she died. Postmortem revealed that the right upper lung carcinoma was the primary lesion and immunohistochemical staining for surfactant protein was positive in the thyroid, skin tumor and lymph node, which revealed these carcinomas had metastasized from lung cancer. To the best of our knowledge, thyrotoxicosis induced by thyroid metastasis of lung cancer is an uncommon case.     

External ultrasonography of the neck does not add diagnostic value to integrated positron emission tomography-computed tomography (PET-CT) scanning in the diagnosis of cervical lymph node metastases in patients with esophageal carcinoma

One of the objectives of preoperative imaging in esophageal cancer patients is the detection of cervical lymph node metastases. Traditionally, external ultrasonography of the neck has been combined with computed tomography (CT) in order to improve the detection of cervical metastases. In general, integrated positron emission tomography-computed tomography (PET-CT) has been shown to be superior to CT or PET regarding staging and therefore may limit the role of external ultrasonography of the neck. The objective of this study was to determine the additional value of external ultrasonography of the neck to PET-CT. This study included all patients referred our center for treatment of esophageal carcinoma. Diagnostic staging was performed to determine treatment plan. Cervical lymph nodes were evaluated by external ultrasonography of the neck and PET-CT. In case of suspect lymph nodes on external ultrasonography or PET-CT, fine needle aspiration (FNA) was performed. Between 2008 and 2010, 170 out of 195 referred patients underwent both external ultrasonography of the neck and PET-CT. Of all patients, 84% were diagnosed with a tumor at or below the distal esophagus. In 140 of 170 patients, the cervical region was not suspect; no FNA was performed. Seven out of 170 patients had suspect nodes on both PET-CT and external ultrasonography. Five out of seven patients had cytologically confirmed malignant lymph nodes, one of seven had benign nodes, in one patient FNA was not performed; exclusion from esophagectomy was based on intra-abdominal metastases. In one out of 170 patients, PET-CT showed suspect nodes combined with a negative external ultrasonography; cytology of these nodes was benign. Twenty-two out of 170 patients had a negative PET-CT with suspect nodes on external ultrasonography. In 18 of 22 patients, cervical lymph nodes were cytologically confirmed benign; in four patients, FNA was not possible or inconclusive. At a median postoperative follow-up of 15 months, only 1% of patients developed cervical lymph node metastases. This study shows no additional value of external ultrasonography to a negative PET-CT. According to our results, it can be omitted in the primary workup. However, suspect lymph nodes on PET-CT should be confirmed by FNA to exclude false positives if it would change treatment plan.     

An adult case of cervico-mediastinal lymph nodes tuberculosis followed by the development of pulmonary lesions during the treatment with antituberculous drugs

A 27-year-old man was admitted to our hospital due to a painful mass in the right neck and fever. Cervical and superior mediastinal computed tomography showed an enlargement of right supraclavicular lymph node and multiple swollen mediastinal lymph nodes, including low-density areas and contrast medium-enhanced septa and margins. Smears of the pus obtained from right supraclavicular lymph node showed acidfast bacilli identified as Mycobacterium tuberculosis by PCR method. He was treated with antituberculous drugs with INH, RFP, EB, and PZA. PZA was given for initial two months. Six months later, productive cough developed and chest X-ray films showed infiltrative shadow in the right upper lung field. One month after the onset of cough, bronchoscopy revealed a polypoid lesion with a white coating in the right main bronchus. Microscopic examination of the specimen obtained by transbrochial biopsy revealed many epithelioid cell granulomas, consistent with tuberculosis. From these findings, pulmonary lesion was suggested to be due to invasion of the mediastinal lymph node into the bronchus. After one year of antituberculous chemotherapy, the swelling of the cervical-mediastinal lymph nodes was reduced and the abnormal chest X-ray shadows disappeared.     

Anaplastic thyroid carcinoma in a 49 year-old woman with a long-standing goiter. A case report

A 49 year-old woman with anaplastic thyroid carcinoma came, for the first time, to our clinic with an enlarged supraclavicular lymph node. Ten years earlier she received a diagnosis of benign nodular goiter and has been followed up with ultrasonography, which never demonstrated any enlargement of her thyroid nodule and with fine needle aspiration biopsies (FNAB), that always proved normal. An ultrasonographic control, performed 10 months before diagnosis, showed the onset of a shell calcification all around the thyroid nodule that forbade the performance of FNAB. At initial examination in our endocrinology centre she was found to have an enlarged thyroid nodule (changing from 3.5 cm to 4.5 cm) and a supraclavicular lymph node 3 cm wide. The patient was therefore sent to the surgeon who performed a total thyroidectomy and a lymph node exenteration. The histological examination reported a thyroid anaplastic carcinoma, composed of osteoclast-like cells and large calcifications, which showed signs of local invasion and vessel infiltration; the supraclavicular lymph node proved to be a large metastasis of anaplastic thyroid cancer. Total body CT scan, bone scintigraphy and brain CT scan showed, respectively, lung, bone and brain metastasis. Postoperative chemotherapy was rapidly interrupted for acute toxicity. The patient died for lung, bone and brain metastasis, 2 months after initial examination.     

A case of adenocarcinoma of the lung presenting symptoms of choroidal metastasis as the initial clinical manifestation]

A 51-year-old woman was referred to our hospital with a complaint of disturbance in vision. Ophthalmologic examination revealed multiple choroidal tumors. High-resolution CT showed a nodular shadow in the left lower lobe. Transbronchial biopsy and right supraclavicular lymph node biopsy specimens showed a poorly-differentiated adenocarcinoma. We concluded that the choroidal tumors had metastasized from the lung. Combined chemotherapy (CDDP + CPT-11) followed by irradiation of both eyes and brain were performed. Nevertheless, she died 6 months after the initial presentation. It is important to notice ophthalmologic symptoms because lung cancer may metastasize to the choroids.     

肺癌的锁骨上淋巴结转移特点及靶区勾画建议

目的探寻未手术及放疗的肺癌行根治性或预防性放疗锁骨上淋巴结靶区勾画的范围。方法将锁骨上区域按主要解剖转移途径分区,回顾分析肺癌在锁骨上淋巴结的转移分布特点,进一步精确肺癌在锁骨上淋巴结靶区勾画范围。结果在所有有锁骨上淋巴结转移的肺癌病例中有双侧锁骨上淋巴结的占31%。锁骨上淋巴结Ⅰ区出现的占22%,多数以与其他区(如Ⅱ区及Ⅳ区)同时出现。锁骨上Ⅱ区淋巴结占绝大部分,99%,与他区一同出现或单独出现。锁骨上Ⅲ区出现淋巴结约3.9%,且全部合并有Ⅱ区淋巴结转移,多伴有大的肿瘤负荷,纵隔及锁骨上广泛的淋巴结转移。Ⅳ区出现淋巴结占16%,均合并有Ⅰ区或Ⅱ区淋巴结。结论推荐出现一侧锁骨上淋巴结转移者行双侧锁骨上淋巴结区预防照射;Ⅰ区需包括;重点勾画Ⅱ区锁骨上淋巴结区;不推荐在锁骨上淋巴结区域预防性勾画时包Ⅲ区,但在Ⅱ区淋巴结肿瘤负荷较大时可个体化适当包;推荐在Ⅰ区或Ⅱ区较大肿瘤负荷时考虑扩展Ⅱ区范围至Ⅳ区。     

胸段食管鳞癌淋巴结转移规律及淋巴结清扫方式探讨

目的探讨胸段食管鳞癌淋巴结转移规律及术中淋巴结清扫方式。方法 480例行根治术的胸段食管鳞癌患者,标记各部位清扫淋巴结分别送检,进行临床病理资料分析。结果本组386例患者有淋巴结转移。全组清扫淋巴结5 424枚,平均每例清扫11.3枚,689枚淋巴结有转移。22例患者出现跳跃性淋巴结转移,其中胸上段3例、中段9例、下段1例。胸上段食管鳞癌颈部淋巴结转移率47.6%,高于胸中段（10.5%）和胸下段（1.3%）,P均〈0.05。胸下段食管鳞癌向腹腔淋巴结转移率为33.1%,高于胸中段（19.4%）和胸上段（3.8%）,P均〈0.05。胸中段食管鳞癌有上纵隔淋巴结（23.5%）及下纵隔淋巴结（29%）和腹腔淋巴结（19.4%）的双向转移趋势,隆突下淋巴结转移多见,转移率54.2%。结论 胸上段食管癌淋巴结转移以颈段食管旁、锁骨上、上中纵隔转移多见,胸中段食管癌淋巴结转移具有明显的上下双向转移和跳跃性转移特点,胸下段食管癌淋巴结转移以腹部、中下纵隔转移多见。胸上段食管癌行颈、胸、腹三野淋巴结清扫,重点清扫颈段食管旁及锁骨上、下界包括隆突下淋巴结;胸下段食管癌可行胸、腹两野淋巴结清扫,重点清扫隆突下、下胸段食管旁、胃左动脉旁淋巴结;胸中段食管癌淋巴结清扫方式应根据具体情况设定。     

Comparison of endobronchial ultrasound, positron emission tomography, and CT for lymph node staging of lung cancer

STUDY OBJECTIVES: To perform a prospective comparison of direct real-time endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA), positron emission tomography (PET), and thoracic CT for detection of mediastinal and hilar lymph node metastasis in patients with lung cancer considered for surgical resection. DESIGN: Prospective patient enrollment. SETTING: University teaching hospital. PATIENTS: One hundred two potentially operable patients with proven (n = 96) or radiologically suspected (n = 6) lung cancer were included in the study. INTERVENTIONS: CT, PET, and EBUS-TBNA were performed prior to surgery for the evaluation of mediastinal and hilar lymph node metastasis. The convex probe EBUS, which is integrated with a convex scanning probe on its tip, was used for EBUS-TBNA. Surgical histology was used as the "gold standard" to confirm lymph node metastasis unless patients were found inoperable for N3 or extensive N2 disease proven by EBUS-TBNA. Main results: EBUS-TBNA was successfully performed in all 102 patients (mean age, 67.8 years) from 147 mediastinal and 53 hilar lymph nodes. EBUS-TBNA proved malignancy in 37 lymph node stations in 24 patients. CT identified 92 positive lymph nodes, and PET identified 89 positive lymph nodes (4 supraclavicular, 63 mediastinal, 22 hilar). The sensitivities of CT, PET, and EBUS-TBNA for the correct diagnosis of mediastinal and hilar lymph node staging were 76.9%, 80.0%, and 92.3%, respectively; specificities were 55.3%, 70.1%, and 100%, and diagnostic accuracies were 60.8%, 72.5%, and 98.0%. EBUS-TBNA was uneventful, and there were no complications. CONCLUSION: Compared to CT and PET, EBUS-TBNA has a high sensitivity as well as specificity for mediastinal and hilar lymph node staging in patients with lung cancer. EBUS-TBNA should be considered for evaluation of the mediastinum early in the staging process of lung cancer.     

Transthorakale und endobronchiale Thoraxsonographie beim Bronchialkarzinom

Transthoracic and endobronchial ultrasound play an important role in the diagnostics and staging in patients with lung cancer. Transthoracic ultrasonography facilitates the evaluation of lung lesions adhering to the pleura and chest wall, pleural effusions, supraclavicular lymph node enlargements and osteolysis. Endobronchial ultrasound allows the detection of peripheral lung lesions and tumor infiltration of the tracheobronchial wall. In combination with transesophageal ultrasound, endobronchial ultrasound enables full mediastinal staging. Through sonographic imaging a targeted cytological or histological sampling can be achieved.     

Lymph node size and metastatic infiltration in non-small cell lung cancer

BACKGROUND: Preoperative lymph node staging of lung cancer by CT relies on the premise that malignant lymph nodes are larger than benign ones. Lymph nodes > 1 cm in size are regarded as metastatic nodes. The surgical approach and potential application of neoadjuvant therapy regimens are dependent on this evaluation. PATIENTS AND METHODS: In a morphometric study, hilar and mediastinal lymph nodes from 256 patients with non-small cell lung cancer (NSCLC) were analyzed. The lymph nodes were counted, the largest diameter of each lymph node was measured, and each lymph node was analyzed for metastatic involvement by histopathologic examination. The frequency of metastatic involvement was calculated and correlated with lymph node size. Preoperative CT scans of 80 patients were retrospectively analyzed by a staff radiologist. Lymph node size was measured, and lymph nodes were evaluated due to radiologic criteria. The radiologic evaluation was compared to the histopathologic diagnosis. RESULTS: A total of 2,891 lymph nodes were present in the 256 specimens examined for this study. One hundred thirty-nine patients had a pN0 status, whereas 117 patients had lymph nodes that were positive for cancer. Two thousand four hundred eighty-six lymph nodes (86%) were tumor-free, while 405 (14%) showed metastatic involvement on histopathologic examination. The mean (+/- SD) diameter of the nonmetastatic lymph nodes was 7.05 +/- 3.75 mm, whereas infiltrated nodes had a diameter of 10.7 +/- 4.7 mm (p = 0.005). One thousand nine hundred fifty-three of the tumor-free lymph nodes (79%) and 170 of the metastatic lymph nodes (44%) were < 10 mm in diameter. Of 139 patients with no metastatic lymph node involvement, 101 (77%) had at least one lymph node that was > 10 mm in diameter. Of 127 patients with metastatic lymph node involvement, 12% had no lymph node that was < 10 mm. The independent radiologic evaluation of the CT scans of 80 patients yielded a sensitivity of 57.1% and a specificity of 80.6%. CONCLUSION: Lymph node size is not a reliable parameter for the evaluation of metastatic involvement in patients with NSCLC.     

可切除性肺癌胸内淋巴结转移的临床研究

目的　探讨可切除性肺癌的胸内淋巴结转移规律。方法　收集１９９２ 年１ 月～１９９８ 年７月可切除性肺癌１６０ 例,在肺癌术中分区摘除肺门淋巴结（Ｎ１） 和纵隔淋巴结（Ｎ２）,记录各区淋巴结的数量、大小和颜色,按区检查每一个淋巴结有无转移癌。结果　１６０ 例肺癌中有淋巴结转移者９９ 例（６１－９％ ）,Ｎ２ 转移者７３ 例（４５－６％ ） 。离肺门或肺根部最近的１１、１０ 、７、５ 和４ 区淋巴结的转移频度较高,较远的９、６、３、２ 和１ 区则明显降低。淋巴结≥２ ｃｍ 的癌转移度为６０－７ ％ 、≥１ ｃｍ 为１５－５％ 、＜ １ｃｍ 为４－３％ 。有转移癌的最小淋巴结为０－２ ｃｍ 。小细胞肺癌（ＳＣＬＣ）的淋巴结转移明显高于非小细胞肺癌（ＮＳＣＬＣ）（ Ｐ＜ ０－０５） 。结论　多数肺癌的淋巴结转移遵循由近向远、由下向上、由肺内经肺门向纵隔顺序转移的规律。淋巴结转移与肿瘤的部位、大小、病程均无关,ＳＣＬＣ更易发生淋巴结转移。确诊淋巴结有无转移癌必须依靠病理检查。     

Endobronchial ultrasonography for mediastinal and hilar lymph node metastases of lung cancer

STUDY OBJECTIVES: Conventional radiologic procedures are frequently unreliable in the diagnosis of mediastinal and hilar lymph node metastases of lung cancer. In order to improve diagnostic accuracy, we performed endobronchial ultrasonography (EBUS) during bronchofiberscopic examinations of patients with lung cancer. METHODS AND PATIENTS: To evaluate mediastinal and hilar lymph node metastases, EBUS was performed prospectively using a radial scanning probe of 20 MHz through a bronchofiberscope. RESULTS: We observed hilar lymph nodes (10R, 11R superior, 11R inferior, 12R, 10L, 11L, 12L) in 20 of 37 patients who underwent EBUS, and we could clearly identify whether direct invasion of the pulmonary artery by a lymph node had occurred. Of the 27 patients who showed no hilar lymph nodes on chest CT scan, lymph node swellings < 10 mm or > or = 10 mm in diameter were identified by EBUS in 9 patients and 2 patients, respectively. Interestingly, EBUS also revealed that the pulmonary artery was directly invaded by an interlobar lymph node < 10 mm in diameter in one patient. In most patients, lymph node 7 was easily identified and was clearly differentiated from the surrounding esophagus, vessels, and mediastinal fat tissue by EBUS. However, fused lymph nodes or lymph nodes with low central density when visualized by chest CT scan were occasionally observed as independent lymph nodes by EBUS. When compared with the pathologic diagnosis of lymph node metastasis in 16 patients who underwent surgery, the most specific and sensitive method for identifying lymph node metastases were EBUS alone (92%) and EBUS in combination with CT scan (100%), respectively. The overall accuracy of EBUS was 94% for the diagnosis of direct invasion of the pulmonary arteries by a hilar lymph node. CONCLUSIONS: EBUS in combination with conventional radiologic tools may contribute to improved staging, especially in surgical cases with hilar lymph node metastases.     

Efficacy of Endoscopic Ultrasonography in the Diagnosis of Lateral Lymphatic Spread in Rectal Cancer

Abstract: In rectal cancer, lateral lymphatic spread is considered to worsen the prognosis. Therefore, accurate determination of lymph node involvement preoperatively is helpful in assessing the malignant character of the tumor and in determining resectability. The present study was performed to evaluate the accuracy, limitations, and usefulness of endoluminal ultrasonography in preoperatively diagnosing the localization of lymph node metastasis in rectal cancer. Seventy-six patients with rectal cancer underwent preoperative endoscopic ultrasonography. Three of these patients had lateral lymphatic spread and all could be distinguished on endoscopic ultrasonography by the detection of involvement of lymph nodes in the anterior rectal space. These findings suggest that endoscopic ultrasonography plays a potentially useful role in the strategy for dealing with rectal cancer prior to surgery.     

Mediastinal lymphadenopathy: an extrahepatic manifestation of chronic hepatitis C?

Normal and enlarged perihepatic and mediastinal lymph nodes are detectable by ultrasonography. Aim of the present study is to determine the detection rate, size, and correlation of mediastinal and perihepatic lymphadenopathy in patients with chronic hepatitis C, healthy controls, and patients with inflammatory or neoplastic mediastinal lymphadenopathy. The mediastinum and liver hilus of 89 patients with chronic hepatitis C as well as of 34 healthy volunteers and 20 patients with mediastinal lymphadenopathy of different origin with adequate sonographic visualization were screened for the number and size of lymph nodes by high resolution ultrasonography. Lymph nodes were detectable in the mediastinum of 75/89 (84%) patients with chronic hepatitis C and 22/34 (65%) healthy volunteers (total lymph node volume [LNV]: 1.0 +/- 0.8 mL versus 0.3 +/- 0.4 mL, p < 0.001). In all patients with mediastinal lymphadenopathy, the mediastinal lymph node volume was above 15 mL. In patients with chronic hepatitis C a trend could be observed, that patients with larger perihepatic lymph nodes reveal also larger mediastinal lymph nodes. High resolution ultrasonography is able to detect enlarged mediastinal lymph nodes in patients with chronic hepatitis C. Mediastinal lymphadenopathy is considered as an extrahepatic manifestation of chronic hepatitis C. In general, the mediastinal lymph node volume differs in size to patients with lymphadenopathy related to neoplasia or sarcoidosis. The mechanism of lymphadenopathy in the liver hilus and mediastinum in patients with chronic hepatitis C is yet unknown.     

Cervical lymph nodes metastases in patients with differentiated thyroid cancer

Loco-regional recurrences of the differentiated thyroid cancer have been reported to be located in cervical lymph nodes in 60-75% of cases. The widespread use of neck ultrasonography (US) during the follow-up of patients with papillary thyroid carcinoma (PTC) has led to the discovery of small cervical lymph nodes (LN). Although US has a high sensitivity for diagnosing LN, fine needle aspiration biopsy (FNA) and measurement of thyroglobulin in fine needle aspirates (FNA-Tg) have proven to be invaluable tools. The aim of this paper is to review the importance of the early diagnosis of lymph node metastases in the follow-up of patients with differentiated thyroid cancer.     

A Case Report: Systemic Lymph Node Tuberculosis Mimicking Lymphoma on 18F-FDG PET/CT

¹⁸F-fluorodeoxyglucose positron emission tomography—an established modality for evaluating malignancies—exhibits increased uptake under inflammatory conditions.A 21-year-old man came to our hospital with persistent pain in his right lower quadrant of abdomen for more than 1 month, but had no diarrhea, fever, chills, weight loss, or other constitutional symptoms. Colonoscopy analysis showed no organic diseases in his colorectum. Ultrasound results revealed multiple enlarged lymph nodes in the bilateral neck, axilla, and groin. Positron emission tomography analysis was performed and showed intense ¹⁸F-fluorodeoxyglucose accumulation in the bilateral neck, supraclavicular, pulmonary hilar, mediastinum, gastric paracardial, and mesenterium lymph node. These findings were considered typical for lymphoma. To confirm the diagnosis, we obtained a diagnostic biopsy in the left supraclavicular lymph node. The diagnosis of tuberculosis was confirmed in the final pathology.This uncommon case underscores the necessity of considering lymph node tuberculosis as a possible differential diagnosis in lymphoma.     

颈部淋巴结结核的二维超声声像图表现及病理对照分析

目的 分析颈部淋巴结结核的二维超声声像图表现,并与病理结果对照。方法 搜集2015年9月至2019年8月就诊于北京结核病控制研究所的淋巴结结核患者63例,其中,男16例(25.4%),女47例(74.6%);年龄18~70岁,中位年龄(四分位数)为29(25,43)岁;共累及101枚淋巴结。回顾性对照分析研究对象颈部淋巴结结核超声声像图表现与病理结果。结果 63例颈部淋巴结结核患者双侧受累者27例(42.9%),左侧受累者14例(22.2%),右侧受累者22例(34.9%)。根据国际通用7分区法,101枚病变淋巴结中位于颌下及颏下(Ⅰ区)3枚(2.9%),位于胸锁乳突肌周围(Ⅱ、Ⅲ、Ⅳ区)84枚(83.2%),位于锁骨上区及颈后三角区(Ⅴ区)14枚(13.9%),位于颈前区(Ⅵ区)0枚,位于上纵隔(Ⅶ区)0枚;病变淋巴结多呈椭圆形和类圆形,大部分为散在分布,少部分相互融合。病变淋巴结按超声声像图表现可分为5种类型:实质炎症型18枚(17.8%)、干酪坏死型39枚(38.6%)、周围炎症型19枚(18.8%)、脓肿窦道型6枚(6.0%)、愈合钙化型19枚(18.8%)。结论 颈部淋巴结结核的二维超声声像图表现与其病理变化密切相关,超声声像图可直观反映病变的各个阶段,可作为该病的首选影像学检查方法。     

Rationale for extent of lymph node dissection for right colon cancer

PURPOSE: The extent of lymph node dissection optimal for the prognosis of right colon cancer is investigated. METHODS: Between 1946 and 1991, 275 patients had curative operation for right colon cancer. A retrospective analysis of rate and degree of lymph node metastasis was performed in each of the 275 patients, and survival rate was estimated in 197 patients who could be followed over a period of three years or more. RESULTS: In most of the curative operative cases of right colon cancer, metastasis to epicolic and paracolic nodes was restricted up to 10 cm proximal or distal to the tumor margin, and metastasis in the central direction was restricted up to main nodes. When cancer metastasized to infrapyloric lymph nodes, dissection of the nodes resulted in a higher rate of long-term prognosis. The five-year cumulative survival rates showed no statistically significant difference between any two of the N0 to N3 lymph node metastasis groups. CONCLUSION: The dissection procedure for right colon cancer involved removal of 10 cm of normal bowel both proximal and distal to the lesion and, in the central direction, dissection of regional lymph nodes along the main trunk artery up to main nodes,i.e., nodes situated anterior to the surgical trunk, which was confirmed to have a therapeutically satisfactory benefit. Infrapyloric lymph nodes must be dissected when metastasis to the nodes is suspected. In cases of cecal or ascending colon cancer in which the middle colic artery is no longer the main trunk artery, a right hemicolectomy with resection of only the right branch of the middle colic artery will usually suffice.     

Preoperative cervical lymph node size evaluation in patients with malignant head/neck tumors: comparison between ultrasound and computer tomography

Purpose  The spread of malignant lymph nodes due to malignancies of the head and neck is systematically observed. However, sentinel lymph nodes in the cervical region, such as in the axillary or supraclavicular regions, are not described. Therefore, precise preoperative lymph node screening of all neck compartments is required. Materials and methods  Forty-five patients with a primary malignant tumor in the head and neck area underwent lymph node staging of the head by means of both CT and ultrasound as a preoperative evaluation. The lymph nodes were classified on the origin of the level system proposed by Som et al. (174:837–844, 2000), which is based on the recommendation of the American College of Radiology introduced in 1990. According to the manual measurement of World Health Organization and the Revised Response Evaluation Criteria in Solid Tumors, the longest transversal and longitudinal diameters were measured by ultrasound, while only the two longest transversal diameters were recorded by CT. The study was conducted by two independent observers. These results were compared with the histopathological results as references. Results  Six hundred and twenty-four lymph nodes were detected, 64 of which were malignant. Most of the transformed lymph nodes were found in level IIa, II b and III. A more precise measurement was given using ultrasound. The correct positive rate of sonographically detected malignant lymph nodes was significantly higher compared to the CT reading. Conclusion  Cervical lymph node staging can be performed safely by ultrasound. It is a cheap, easy-to-handle and cost-effective diagnostic method. However, only the uppermost regions of the neck are accessible with a linear transducer. Despite this restriction, ultrasound is a reliable and valuable tool for screening lymph nodes in the case of a head or neck malignancy.     

Intraoperative ultrasonography for the identification of thoracic recurrent laryngeal nerve lymph nodes in patients with esophageal cancer

The rate of vocal cord palsy following resection for esophageal carcinoma has increased due to lymphadenectomy around the recurrent laryngeal nerves (RLN). The aim of this pilot study was to assess the ability of intraoperative ultrasonography to detect thoracic RLN node metastases in patients with esophageal cancer. Intraoperative ultrasonography was performed during esophagectomy to assess whether RLN lymph nodes were metastatic in 10 patients with esophageal squamous cell cancer. All patients underwent RLN lymphadenectomy, and the nodes were assessed for metastasis. Three patients had pathological RLN lymph node metastases, of which one had right RLN node metastasis, and three had left RLN node metastases. For detecting right RLN lymph node metastasis, the sensitivity, specificity, and positive and negative predictive values of intraoperative ultrasonography were 100%, 33.3%, 14.3%, and 100%, respectively. For the detection of left RLN lymph node, these values were 100%, 85.7%, 75%, and 100%, respectively. This study suggests that intraoperative ultrasonography is feasible and safe to detect RLN lymph node metastases for patients with esophageal cancer. Further study will be performed to evaluate the validity and utility of this diagnostic technique.