Reliable sonographic features for nodal thyroglobulin to diagnose recurrent lymph node metastasis from papillary thyroid carcinoma

Objectives

Ultrasound‐guided aspiration cytology (US‐FNAC) was previously used to diagnose lymph node metastasis of papillary thyroid carcinoma (PTC). Combined US‐FNAC with nodal thyroglobulin (LN‐FNA‐Tg) significantly improved the diagnostic rate. However, diagnostic accuracy depends on proper node selection. Therefore, it is crucial to choose the nodes with reliable sonographic features to guide clinician for confirmation.

Design and Setting

Retrospective cohort study was carried out in one medical centre from 2011 to 2014.

Participants

A total of 148 patients with PTC, being treated by total thyroidectomy and radioiodine, were assessed for potential nodal metastases by ultrasound.

Main outcome measures

Lymph nodes with cystic content, peripheral hypervascularity, calcification, hyperechoic content, the absence of hilum and Solbiati index < 2 indicated risk of malignancy. US‐FNAC and LN‐FNA‐Tg were both performed. Positive nodal metastasis was further confirmed by dissection. Risk impact of these sonographic features on LN‐FNA‐Tg to diagnose nodal metastasis was tested by logistic regression analysis based on the significance in both univariate and multivariate models.

Results

Overall, 49 lymph nodes were documented as recurrent nodal metastasis. LN‐FNA‐Tg greater than serum thyroglobulin and higher than 1 ng/mL achieved 100% of diagnostic rate for recurrent nodal metastasis. The malignant sonographic features that significantly cohered with positive LN‐FNA‐Tg were cystic and hyperechoic content and lack hilum, in sequence.

Conclusions

LN‐FNA‐Tg is an excellent tool to quantitatively diagnose nodal metastasis. To achieve ideal diagnosis, the most reliable sonographic features were cystic content, hyperechoic content and the absence of hilum in lymph nodes, but not calcification or Solbiati index < 2.     

甲基强的松龙对狼疮性肾炎患者血浆中PAI-1的影响

目的 :研究甲基强的松龙对Ⅳ型狼疮性肾炎 (LN)患者血浆中 1型纤溶酶原激活物抑制物 (PAI 1)的影响。方法 :应用免疫组织化学ELISA方法检测患者血浆中PAI 1含量。结果 :①LN治疗组与对照组比较 (P <0 0 1) ;②LN患者经甲基强的松龙两次冲击治疗后与治疗前分别比较 (P <0 .0 1) ;③甲基强的松龙第二次冲击治疗后 ,与对照组比较无显著性差异 (P >0 0 5 )。结论 :甲基强的松龙通过干扰纤溶酶原激活物 (PA) 纤溶酶系统 ,使LN病人血浆中PAI 1含量明显降低 ,从而发挥治疗作用。     

Development and validation of a nomogram for predicting survival on the base of modified lymph node ratio in breast cancer patients

BackgroundAxillary lymph node status is one of the most important prognostic factors in breast cancer and previous studies indicated that lymph node ratio (LNR) could better predict the outcome than the counting of positive lymph nodes. In the current study, we evaluated the prognostic effect of modified LNR in breast cancer patients.MethodsA total of 3339 breast cancer patients undergoing axillary lymph nodes dissection were enrolled and respectively analyzed. Seventy five percent of participants were randomly selected as training cohort and the remaining 25% were as validation cohort. Univariate and multivariate analyses were performed and the prognostic impact of mLNR was compared with pN staging. A prognostic nomogram was established and externally validated in the validation cohort.ResultIn multivariate analysis, both the mLNR and pN staging were independent prognostic factors for breast cancer patients, and the mLNR manifested superior discrimination power than the pN stages regardless of the total number of lymph nodes retrieved and the lymph node status. The nomogram was built including the identified independent prognostic factors and the calibration curves indicated optimal agreement between nomogram prediction and actual observation. The Concordance index (C-index) of the nomogram was statistically higher than that of the TNM system (0.747 vs. 0.711 in training cohort, 0.789 vs. 0.760 in validation cohort, both p < 0.05).ConclusionModified LNR is an important prognostic parameter and can predict survival more accurately than pN staging. The novel nomogram could provide individual prediction for breast cancer patients and help clinicians in treatment option making and prognosis evaluation.     

Prognostic Value of Metabolic Parameters of Metastatic Lymph Nodes on 18F-FDG PET/CT in Patients With Limited-stage Small-cell Lung Cancer With Lymph Node Involvement

Introduction

We assessed the prognostic value of the metabolic parameters of different lesions, including primary tumors and metastatic lymph nodes (LNs), measured by fluorine-18 fluorodeoxyglucose positron emission tomography (PET)/computed tomography in patients with limited-stage small-cell lung cancer (LS-SCLC) with LN metastasis.

CT-Guided Percutaneous Needle Biopsy of Retroperitoneal and Pelvic Lymphadenopathy: Assessment of Technique,Diagnostic Yield,and Clinical Value

Purpose

To assess the technical success rate, diagnostic yield, and clinical value of computed tomography (CT)–guided percutaneous needle biopsy (PNB) for retroperitoneal and pelvic lymphadenopathy.