AutoLNMNet: Automated Network for Estimating Lymph-Node Metastasis in EGC Using a Pyramid Vision Transformer and Data Derived From Multiphoton Microscopy.

Lymph-node status is important in decision-making during early gastric cancer (EGC) treatment. Currently, endoscopic submucosal dissection is the mainstream treatment for EGC. However, it is challenging for even experienced endoscopists to accurately diagnose and treat EGC. Multiphoton microscopy can extract the morphological features of collagen fibers from tissues. The characteristics of collagen fibers can be used to assess the lymph-node metastasis status in patients with EGC. First, we compared the accuracy of four deep learning models (VGG16, ResNet34, MobileNetV2, and PVTv2) in training preprocessed images and test datasets. Next, we integrated the features of the best-performing model, which was PVTv2, with manual and clinical features to develop a novel model called AutoLNMNet. The prediction accuracy of AutoLNMNet for the no metastasis (Ly0) and metastasis in lymph nodes (Ly1) stages reached 0.92, which was 0.3% higher than that of PVTv2. The receiver operating characteristics of AutoLNMNet in quantifying Ly0 and Ly1 stages were 0.97 and 0.97, respectively. Therefore, AutoLNMNet is highly reliable and accurate in detecting lymph-node metastasis, providing an important tool for the early diagnosis and treatment of EGC.

The role of TMEM163 protein in thyroid microcarcinoma: expression pattern and clinical implications.

BACKGROUND: TMEM163 protein is a new zinc ion transporter whose regulatory role in tumors has yet to be discovered. This study aimed to analyze the expression pattern of TMEM163 in thyroid microcarcinoma and explore its potential molecular function and clinical value. METHODS: Differential analysis was performed to detect the expression pattern of TMEM163 in papillary thyroid carcinoma. Functional analysis was performed to explore the biological function of TMEM163. Logistic regression was performed to detect the relationship between TMEM163 expression and lymph node metastasis. A correlation analysis of the relationship between 163 and anoikis was performed. qRT-PCR and western blot were used to verify its expression in PTC tissues. The effect of TMEM163 on PTC cell function was studied by a series of in vitro cell experiments. The prediction model of lymph node metastasis was constructed based on the ultrasonic characteristics of PTMC and the expression of TMEM163. RESULTS: The expression of TMEM163 in PTC tissue was higher than in normal thyroid tissue. In vitro, silencing TMEM163 inhibited PTC cells' proliferation, migration, and invasion, while TMEM163 overexpression exhibited the opposite effect. In addition, down-regulating its expression can inhibit the cell cycle process and induce the apoptosis of tumor cells. In pathway analysis, we demonstrated that knockout of TMEM163 significantly increased p21 expression and inhibited BCL-2 expression. Logistic regression results suggested that the expression of TMEM163 combined with PTMC ultrasound characteristics helped predict lymph node metastasis. CONCLUSION: TMEM163 is highly expressed in PTC, which may be involved in the mechanism of anoikis, and can be used as a molecular marker to predict PTMC lymph node metastasis.

A near-infrared fluorescent probe with assembly/aggregation-induced retention effect for specific diagnosis of metastasis and image-guided surgery in breast cancer.

Image-guided surgery is crucial for achieving complete tumor resection, reducing postoperative recurrence and improving patient survival. However, current clinical near-infrared fluorescent probes, such as indocyanine green (ICG), face two main limitations: 1) lack of active tumor targeting, and 2) short retention time in tumors, which restricts real-time imaging during surgery. To address these issues, we developed a near-infrared fluorescent probe capable of in situ nanofiber formation within tumor lesions. This probe actively targets the integrin αvß3 receptors overexpressed on breast cancer cells and exhibits assembly/aggregation-induced retention effects at the tumor site, significantly extending the imaging time window. Additionally, we found that the probe's fluorescence intensity can be enhanced under receptor induction. Due to its excellent tumor specificity and sensitivity, 1FCG-FFGRGD not only identifies primary breast cancer but also precisely locates smaller lymph node metastases and detects sub-millimeter peritoneal metastases. In summary, this near-infrared probe, leveraging assembly/aggregation-induced retention effects, holds substantial potential for various biomedical applications.

Development and external validation of a nomogram for predicting lymph node metastasis in 1-3 cm lung adenocarcinoma.

Aim: This study aimed to investigate the risk factors for lymph node metastasis in 1-3 cm adenocarcinoma and develop a new nomogram to predict the probability of lymph node metastasis.Materials & methods: This study collected clinical data from 1656 patients for risk factor analysis and an additional 500 patients for external validation. The logistic regression analyses were employed for risk factor analysis. The least absolute shrinkage and selection operator regression was used to select variables, and important variables were used to construct the nomogram and an online calculator.Results: The nomogram for predicting lymph node metastasis comprises six variables: tumor size (mediastinal window), consolidation tumor ratio, tumor location, lymphadenopathy, preoperative serum carcinoembryonic antigen level and pathological grade. According to the predicted results, the risk of lymph node metastasis was divided into low-risk group and high-risk group. We confirmed the exceptional clinical efficacy of the model through multiple evaluation methods.Conclusion: The importance of intraoperative frozen section is increasing. We discussed the risk factors for lymph node metastasis and developed a nomogram to predict the probability of lymph node metastasis in 1-3 cm adenocarcinomas, which can guide lymph node resection strategies during surgery.

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Para-aortic and pelvic lymphadenectomy in locally advanced cervical cancer with pelvic lymph node metastasis.

OBJECTIVE: This study sought to explore the efficiency of para-aortic and pelvic lymphadenectomy in the treatment of locally advanced cervical cancer (LACC) with pelvic lymph node (PLN) metastasis. METHODS: A total of 171 LACC patients with imaging-confirmed pelvic lymph node metastasis were included in this study. These patients were divided into two groups: the surgical staging group, comprising 58 patients who had received para-aortic and pelvic lymphadenectomy (surgical staging) along with concurrent chemoradiation therapy (CCRT), and the imaging staging group, comprising 113 patients who had received only CCRT. The two groups' progression-free survival (PFS), overall survival (OS) and treatment-related complications were compared. RESULTS: The surgical staging group started radiotherapy 10.2 days (range 9-12 days) later than the imaging staging group. The overall incidence of lymphatic cysts was 9.30%. In the surgical staging group, para-aortic lymph node metastasis was identified in 34.48% (20/58) of patients, while pathology-negative PLN was observed in 12.07% (7/58). Over a median follow-up period of 52 months, no significant differences in PFS and OS rates were found between the two groups (p > 0.05). Subgroup analysis of patients with lymph node diameters of ≥ 1.5 cm revealed a five-year PFS rate of 75.0% and an OS rate of 80.0% in the surgical staging group, compared to 41.5% and 50.1% in the imaging staging group, respectively, showing statistically significant differences (p = 0.022, HR:0.34 [0.13, 0.90] and p = 0.038, HR: 0.34 [0.12,0.94], respectively for PFS and OS). Additionally, in patients with two or more metastatic lymph nodes, the five-year PFS and OS rates were 69.2% and 73.1% in the surgical staging group, versus 41.0% and 48.4% in the imaging staging group, with these differences also being statistically significant (p = 0.025, HR: 0.41[0.19,0.93] and p = 0.046, HR: 0.42[0.18,0.98], respectively). CONCLUSION: Performing surgical staging before CCRT is safe and delivers accurate lymph node details crucial for tailoring radiotherapy. This approach merits further investigation, particularly in women with pelvic lymph nodes measuring 1.5 cm or more in diameter or patients with two or more imaging-positive PLNs.

Etiological Spectrum of Lymphadenopathy Among Children on Lymph Node Biopsy.

Background Pediatric peripheral lymphadenopathy is commonly a benign condition and most cases resolve spontaneously; however, it can be a manifestation of a serious underlying disease. This study aimed to determine the etiological spectrum of persistent pediatric lymphadenopathy on excisional biopsy in a tertiary care children's hospital in a low-middle-income country and to make recommendations regarding evaluation, diagnostic testing, and surgical interventions best suited to the population. Methodology A prospective cross-sectional study was conducted on 243 pediatric patients between the ages of one to 12 years undergoing excisional biopsy for persistent lymphadenopathy (more than four weeks duration) from April 1, 2021, to March 31, 2024. Patient demographic data along with signs, symptoms, and results of investigations including histopathological diagnosis were documented on a structured proforma. Results Patients' age range was two to 12 years (mean = 7.29 ± 2.30 years). The male-to-female ratio was 1:53. The Mean duration of lymphadenopathy was 35.89 ± 6.95 days (range = 25 to 57 days). The average size of lymph nodes ranged from 1 cm to a complex nodal mass of 7 cm. Histopathology showed reactive hyperplasia (40.32%, n = 98), tuberculosis (TB) (33.7%, n = 82), lymphoma (10.3%, n = 25), atypical mycobacterial adenitis (6.99%, n = 17), chronic granulomatous inflammation-histiocytosis (6.2%, n = 15), and Langerhans cell histiocytosis (2.5%, n = 6). The most common site was cervical. Sputum GeneXpert for TB had a true-positive rate of 78.84% while PPD was positive in only 13 TB patients. Atypical mycobacterial adenitis was successfully treated with excision and antibiotics. Supraclavicular nodes were strongly associated with lymphoma (p = 0.008). Conclusions Persistent pediatric lymphadenopathy is most commonly caused by TB followed by lymphoma. Positive sputum GeneXpert for TB with a suggestive clinical picture in endemic regions may be sufficient to start empiric therapy without the need for excisional biopsy in mycobacterial TB adenitis with negative PPD results and normal chest X-ray. In all other cases, excisional biopsy remains the gold standard for diagnosis. However, further studies should be conducted to formulate less invasive management algorithms.

Innovative approaches to controlling Salmonella in the meat industry.

Salmonella, a Gram-negative, rod-shaped bacterium from the Enterobacteriaceae family, is a significant cause of illnesses in humans and animals. It resides in the digestive tracts of livestock, poultry, and other warm-blooded animals and can contaminate various environments and foods through fecal matter. Salmonella enterica, the main species that affects humans, is widespread in cattle, pigs, and poultry. Despite efforts to control pathogens in meat systems, over 1.4 million human salmonellosis cases occur annually in the U.S., with serotypes S. enteritidis and S. typhimurium being predominant. Advances in meat processing have targeted pathogen reduction at multiple stages, but more innovative approaches are needed for substantial public health impact. This paper discusses current and future strategies to minimize Salmonella in the food supply. It emphasizes pre- and post-harvest Salmonella prevalence by biomapping it through the whole processing chain, focusing on beef and pork interventions such as probiotics. These interventions have shown promise in reducing pathogen loads in cattle manure and lymph nodes. Techniques such as microbiome, whole genome sequencing (WGS), and electron microscopy (EM) provide detailed insights into Salmonella's genetic and bacterial structural-morphological characteristics, aiding in the development of targeted interventions. Integrating rapid detection, biomapping, and enviromapping enhances pathogen tracking in meat production, reducing Salmonella prevalence and improving risk assessment and food safety. The advanced, current, and innovative techniques allow for timely identification, detailed spatial and quantitative data, and more effective interventions. This leads to safer food products and reduces foodborne illnesses.

Comparison of three-dimensional vs. two-dimensional assisted thoracoscopy for recurrent laryngeal nerve lymph nodes dissection in esophagectomy: a retrospective study.

BACKGROUND: This study aimed to explore the clinical value of 3D video-assisted thoracoscopic surgery in dissecting recurrent laryngeal nerve lymph nodes in patients undergoing minimally invasive esophagectomy. METHODS: A retrospective cohort study was conducted on 205 patients, including 120 males, who underwent esophagectomy from May 2018 to May 2020 in the Department of Thoracic Surgery at the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University. Perioperative parameters, including intraoperative blood loss, operation time, the number of dissected recurrent laryngeal nerve lymph nodes, the incidence and degree of postoperative recurrent laryngeal nerve injury, the volume of postoperative thoracic drainage, and postoperative complications, were compared between the 3D and 2D groups. RESULTS: There were no significant differences in the preoperative baseline data between these two groups (P > 0.05). The number of dissected recurrent laryngeal nerve lymph nodes in the 3D group was significantly higher than in the 2D group (P < 0.05). The operation times were significantly shorter in the 3D group than in the 2D group (P < 0.05). The volume of thoracic drainage in the first 2 days was significantly less in the 3D group than in the 2D group (P < 0.05). CONCLUSIONS: Compared to the 2D system, the application of 3D video-assisted thoracoscopic surgery in minimally invasive esophagectomy can increase the number of dissected recurrent laryngeal nerve lymph nodes and ensure safety. Additionally, it can reduce the duration of the operation, decrease early postoperative thoracic drainage volume, and promote patient recovery.

Late Metastasis in Conjunctival Adenosquamous Carcinoma.

Purpose: To present a rare case of metastatic conjunctival adenosquamous carcinoma (ASC) in the context of limited literature on the prognosis of ASC and suggested follow-up and surveillance. Case Report: We report a case of conjunctival ASC that metastasized to cervical lymph nodes five years after histological confirmation of complete local excision. Conclusion: Long-term clinical follow-up and surveillance imaging are warranted to allow early detection of disease recurrence and/or metastasis.

Characteristics of lymph node metastasis and short-term outcome of esophageal squamous-cell carcinoma undergoing minimally invasive esophagectomy: a prospective cross-sectional study (with video).

Introduction: Surgery for esophageal squamous-cell carcinoma (ESCC) presents many potential challenges owing to malignant lymph node metastasis, complex procedures and severe postoperative complications. The appropriate lymphadenectomy for ESCC remains controversial. This study aims to evaluate the characteristics of lymph node metastasis and postoperative complications in patients with ESCC undergoing minimally invasive esophagectomy and extended two-field lymph node dissection. Patients and methods: This prospective, single-center, cross-sectional study was conducted from October 2022 to May 2024. All patients with ESCC who underwent minimally invasive esophagectomy and extended two-field lymph node dissection were selected for this study. Postoperative lymph nodes were divided into upper thoracic, middle thoracic, lower thoracic and abdominal lymph node groups. Results: Seventy-four patients with ESCC, including 49 patients who underwent upfront surgery and 25 patients who received preoperative chemoradiotherapy, were selected. The rate of lymph node metastasis in all patients was 39.2%, with 13.6% of patients having upper thoracic metastasis. The factors affecting the rate of lymph node metastasis included preoperative chemoradiotherapy, tumor stage, poor differentiation, lymphovascular/perineural invasion, and tumor size greater than 2 cm, all of which were significantly different (P<0.05). Common postoperative complications included pneumonia (25.7%), recurrent laryngeal nerve (RLN) palsy (10.8%) and anastomotic leak (4.1%). There were no cases required conversion to open surgery, nor any deaths within 90 days postoperatively. Conclusion: Lymph node metastasis in esophageal squamous-cell carcinoma has a high incidence, occurs in the early stages, and is widely distributed in all regions of the mediastinum and abdomen. Minimally invasive esophagectomy and extended two-field lymph node dissection are feasible and safe, with low complication rates.

Spontaneous B-cell lymphoma in the cranial mediastinal lymph node of an aged male C57BL/6J mouse.

B-cell lymphoma is generally observed in the spleen, mesenteric lymph nodes, and Peyer's patches in aged mice and rarely appears in other organs. Herein, we report a case of spontaneous B-cell lymphoma originating from the cranial mediastinal lymph node in a male 75-week-old C57BL/6J mouse. Macroscopically, a white mass was found at the base of the heart with no connection to the thymus. Microscopic examination revealed a solid proliferation of tumor cells with large nuclei at the center of the mass. Some macrophages, normal-sized lymphocytes, and lymphatic sinuses were found in both central and peripheral areas. Immunohistochemical analysis showed positive staining for cluster of differentiation 19, paired box protein 5, immunoglobulin M, and Ki-67 but not for cytokeratin AE1/AE3. These findings were not completely consistent with the established mouse lymphoma classification, leading to a diagnosis of B-cell lymphoma originating from the cranial mediastinal lymph node. This case report is the first to document a B-cell lymphoma in the cranial mediastinal lymph nodes in an aged C57BL/6J mouse.

Short- and long-term immunosuppressive effects of melanoma influence the prognostic value of the sentinel lymph node status.

BACKGROUND: Presence of micrometastases in the sentinel lymph node (SLN) is currently used to assess prognosis of melanoma patients. The immunoactivity within the SLN is known to be influenced by the primary tumor (PT), which may in turn impact the SLNs' metastatic state. AIM: We characterize the temporal dependence and underlying mechanisms of the immunological effects of the PT on the SLN. METHODS: The prognostic value of SLN state as a function of PT removal time was evaluated. To put the results into a functional context, selected PTs and corresponding SLNs were analyzed for gene and protein expression patterns. RESULTS: In a cohort of 202 patients with known distant metastasis and similar PT prognostic characteristics, SLNs removed before or within one week after the PT (IM-SLN) had a higher incidence of micrometastases than those removed at least one week after the PT (DEL-SLN). The immunoactivity in IM-SLN was found to be lower than in DEL-SLN. Specifically, in IM-SLNs, T helper 17 / regulatory T-cells were predominant, whereas in DEL-SLNs, cytotoxic γδT-cells were more frequent. The higher immune activity in DEL-SLNs was probably facilitated by CD209+ antigen-presenting cells. Indeed, in PT with high TGFß expression CD209+ cells appear to be trapped and no increased immunoactivity was observed in DEL-SLN. CONCLUSIONS: Presence of micrometastases in DEL-SLNs have a higher negative prognostic value as in IM-SLNs since they indicate not only a melanoma's propensity to metastasize, but possibly also its capacity to escape immune responses.

Factors influencing lymph node yield in head and neck squamous cell carcinoma: A scoping review.

OBJECTIVES: In head and neck cancer surgery, several studies have demonstrated the prognostic significance of lymph node yield (LNY). To our knowledge, no review has evaluated both the contributing factors to LNY and its impact on survival outcomes across all head and neck squamous cell carcinoma (HNSCC) subsites. MATERIALS AND METHODS: A scoping review of LNY in HNSCC was conducted according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) framework to answer the following research questions: 1) Which surgeon, pathologist, and patient characteristics influence LNY? 2) Which anatomic subsites does LNY impact survival? RESULTS: Surgeon experience and variation in pathology protocols and personnel can impact LNY. Extent of nodal dissection, advanced tumor characteristics, and treatment at an academic facility are associated with increased LNY. Patient characteristics such as age <40, male gender, and BMI > 30 are associated with increased LNY. In the oral cavity, LNY > 18 is an independent predictor of improved overall survival (OS), disease free survival (DFS), and disease-specific survival (DSS). In the oropharynx, published studies show mixed results with regards to the impact of LNY on OS, DFS, and DSS. LNY has not been associated with OS or DFS in the larynx, irrespective of nodal threshold. CONCLUSIONS: Provider and patient characteristics may impact LNY. LNY ≥ 18 is associated with a survival benefit in the oral cavity and HNSCC overall. Further investigation of LNY particularly in prospective clinical trials is required prior to its adoption as a quality metric in HNSCC.

[Diagnosis of lymph node metastases from papillary thyroid carcinoma by measuring thyroglobulin in the puncture needle. Calculation of optimal cut-off point in our series]. / Diagnóstico de metástasis ganglionares de carcinoma papilar tiroideo midiendo tiroglobulina en la aguja de la punción. Cálculo de punto de corte optimo en nuestra serie.

Fine-needle aspiration cytology (FNAC), used in suspicious cervical lymph nodes of unknown origin is frequently inconclusive and prone to false negatives. In order to evaluate the usefulness of measuring thyroglobulin in the washing with saline solution of the puncture needle for the diagnosis of metastasis of papillary carcinoma of the thyroid, an optimal thyroglobulin cutting point has to be calculated, being positive or negative depending on whether the thyroglobulin levels are higher or lower than the cutting point. We have retrospectively studied 33 patients (19 women and 14 men) with an average age of 49.3 years, with papillary carcinoma of the thyroid and suspected lymph node metastasis. Of them 16 (47.1%) had a positive FNAC. To determine thyroglobulin predictive capacity with regards to the metastasis of papillary carcinoma of the thyroid a ROC analysis was carried out with an under curve area UCA: 0.987 (CI 95%: 0.808-1.000) obtaining, using Youden's J statistic, 0.4 ng/ml as the thyroglobulin cutting point with best predictive capacity. The study of the relationship between thyroglobulin and the preservation/non-preservation of the thyroid showed statistically significant differences (P=.023). Our results validate 0.4 ng/ml of thyroglobulin as an optimal cutting point of the presence of metastasis of papillary carcinoma of the thyroid in lymph nodes. When reviewing the bibliography, a great diversity of cutting points may be found, which is explained mainly by the great inter-observer and inter-assay variability. That is why we recommend calculating each laboratory's own optimal cutting point; and determine in subsequent studies two cutting points depending on whether or not thyroid is preserved.

Are Clinically Node-Negative Patients with a Positive Preoperative Axillary Lymph Node Biopsy Appropriate Candidates for Sentinel Lymph Node Biopsy?

BACKGROUND: Whether cN0 patients with image-detected nodal metastases are appropriate for sentinel lymph node biopsy (SLNB) or should proceed directly to axillary lymph node dissection (ALND) or neoadjuvant chemotherapy (NAC) is controversial. We sought to determine how often ALND is needed with upfront surgery and to identify factors associated with ≥ 3 positive SLNs after a positive preoperative lymph node (LN) biopsy. METHODS: Patients with cT1-2N0 breast cancer and a positive LN biopsy treated from 2014 to 2022 were identified from a prospective database. Patients who received NAC were excluded. Clinicopathologic characteristics were compared between women with 1-2 positive SLNs and ≥ 3 positive SLNs. RESULTS: Of 90 eligible patients, 66 (73%) had 1-2 positive SLNs and 24 (27%) had ≥ 3 positive SLNs. The median patient age was 62 years, median tumor size was 2.2 cm, and 16 women (18%) received a mastectomy. There was no difference in body mass index, tumor size, histology, grade, multifocality, presence of lymphovascular invasion, and receptor status between groups. On multivariable analysis, having ≥ 3 positive SLNs was associated with > 1 abnormal LN on preoperative imaging (odds ratio [OR] 4.36, 95% confidence interval [CI] 1.47-14.0; p = 0.01), microscopic extracapsular extension in the SLNs (OR 3.83, 95% CI 1.25-13.7; p = 0.025), and a higher median number of SLNs removed (OR 1.42, 95% CI 1.10-1.88; p = 0.01). CONCLUSIONS: More than 70% of women with cT1-2 breast cancer with image-detected nodal metastases had < 3 positive SLNs and did not require ALND. To avoid multiple trips to the operating room, frozen section can be considered in women with multiple abnormal LNs on imaging.

Clinicopathologic Predictive Factors of Extranodal Extension in Oral Squamous Cell Carcinoma - A Retrospective Analysis.

The implications of extranodal extension (ENE) in oral carcinoma have been often related to prognosis and survival rates. The clinicopathologic predictive factors of this established prognostic factor were analyzed in this retrospective study. A total of 358 medical records of a single institution were screened. Primary outcome variable was ENE. Predictor variables were clinical tumour (cT) and nodal (cN) staging, tumour subsite, and pathologically tumour size, depth of invasion (DOI), lymph node ratio (LNR), presence, or absence of perineural invasion (PNI), lymphovascular invasion (LVI) and mandibular involvement. After scrutinization, 216 records met the inclusion and exclusion criteria. Presence of ENE was noted in 42.1% (91/216) of patients. In cN0 necks ENE was 34.7% which was statistically significant. The cut-off value for tumour size, DOI and LNR were, 7.28 cm, 9 mm and 0.05 with accuracy rates of 68%, 79% and 94% respectively. The odds of presence ENE were highest with bone involvement (2.91) followed by PNI (2.34) and lastly LVI (2.17). In conclusion, these predictive factors can be used to fortify the pathologic diagnostic criteria of ENE. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04886-3.

Utility of Lymph Node Ratio in Predicting Biochemical Incomplete Clinical Response in Patients with Papillary Ca thyroid with Positive Neck Node.

Background: with the requirement of aggressive follow-up in patients with biochemically incomplete response in patients of papillary ca. thyroid with neck node, a predictor for clinical response would be of great help for better treatment and follow-up planning. Aim: To determine the utility of lymph-node ratio (central and lateral) as predictors for clinical response post total thyroidectomy and neck dissection. Materials and methods: 51 patients of papillary carcinoma thyroid with neck node were treated with surgery and RAI as per ATA guidelines and were analyzed for a median of 3 years. (Retrospective cohort analysis). Results: We did response evaluation, correlated clinical response with lymph-node ratios. We found a statistically significant relationship of lymph-node ratio with around a sensitivity and specificity of approximately 90% in predicting the biochemically incomplete response. Conclusion: we conclude that lateral and central compartment ratios can be used in predicting the occurrence of biochemically incomplete response.

Metastatic Axillary Cutaneous Squamous Cell Carcinoma in an African-American Female: A Rare Case.

Cutaneous squamous cell carcinoma (cSCC) is a common skin cancer, typically affecting older White males in sun-exposed areas, and metastasis is rare. We present a unique case of a 46-year-old obese African-American woman with a recurrent, deep abscess in her left axilla. It was initially treated with several incision and drainage procedures and antibiotics. Despite multiple interventions, the abscess recurred with severe pain and drainage. Subsequent biopsies revealed a high-grade malignant neoplasm, later confirmed as poorly differentiated cSCC with primary metastases to the lungs and secondary metastases to the adrenal glands and periaortic lymph nodes. Immunohistochemical staining supported the diagnosis. The patient's atypical presentation, including her race, a non-sun-exposed site, and younger age, highlights the need for vigilance in diagnosing cSCC in atypical cases. This case underscores the importance of early consideration of cSCC in differential diagnoses for persistent or recurrent abscesses, which can facilitate timely treatment, potentially preventing extensive metastasis and improving patient outcomes.

Risk factors for lymph node metastasis in women with FIGO 2018 IA cervical cancer with a horizontal spread of > 7 mm.

BACKGROUND: In the FIGO 2018 classification, women with cervical cancer and a depth of invasion ≤ 5 mm and a horizontal spread of > 7 mm in excisional biopsy with tumour-free margins, are now classified as stage IA instead of IB. This stage shift may reduce the likelihood of surgical lymph node staging. It is therefore crucial to estimate the risk and risk factors of lymph node metastasis (pN+) in this group. METHODS: Women diagnosed with cervical cancer between 2005 and 2022 were identified from nationwide population-based registries from the Netherlands, Denmark, and Sweden. Inclusion criteria were squamous cell carcinoma or adenocarcinoma, FIGO 2009 stage IB1, a depth of invasion ≤ 5 mm and horizontal spread of > 7-≤ 40 mm. All cases underwent radical hysterectomy or radical trachelectomy, and surgical lymph node staging. Logistic regression was used to identify risk factors of pN+. RESULTS: We included 992 women (pN+ 4.1 %; n = 41). Lymphovascular space invasion (LVSI) was a significant risk factor of pN+ (odds ratio 4.26, 95 % confidence interval 2.24-8.32). Accordingly, the risk of pN+ was ≥ 7.3 % in LVSI-positive tumours. The risk was lowest in LVSI-negative tumours with a size of > 7-≤ 20 mm (2.2 %), although this varied by depth of invasion and histological subtype (pN+ range 0.6-5.1 %). CONCLUSION: Women with LVSI-positive FIGO 2018 IA cervical cancer and a horizontal spread > 7 mm, should undergo surgical lymph node staging. In LVSI-negative tumours, lymph node staging should not be routinely performed; tumour size, depth of invasion and histology should be considered.