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Hanzalova I, Matter M. Peripheral lymphadenopathy of unknown origin in adults: a diagnostic approach emphasizing the malignancy hypothesis. Swiss Med Wkly 2024; 154:3549. [PMID: 39154257 DOI: 10.57187/s.3549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2024] Open
Abstract
The term lymphadenopathy refers to an abnormality in size, consistency or morphological aspect of one or several lymph nodes. Although lymphadenopathies are commonly observed in everyday clinical practice, the difficulty of differentiating benign and malignant disease may delay therapeutic approaches. The present review aims to update diagnostic algorithms in different clinical situations based on the currently available literature. A literature review was performed to assess current knowledge of and to update the diagnostic approach. A short clinical vignette was used as an example of a typical clinical presentation. This case of metastatic lymphadenopathy with incomplete patient history demonstrates how misleading such lymphadenopathy may be, leading to a delayed diagnosis and even a fatal outcome. Any lymphadenopathy persisting for more than 2 weeks should be considered suspicious and deserves further investigation. Precise clinical examination, meticulous history-taking and a search for associated symptomatology are still cornerstones for diagnosing the origin of the condition. The next diagnostic step depends on the anatomical region and the specific patient's situation. Imaging starts with ultrasound, while computed tomography (CT) and magnetic resonance imaging (MRI) allow assessment of the surrounding structures. If the diagnosis remains uncertain, tissue sampling and histological analyses should be performed. Except for head and neck loco-regional lymphadenopathy, there are no methodical guidelines for persistent lymphadenopathy. The present review clarifies several confusing and complex situations. The accuracy of fine needle aspiration cytology could be increased by using core needle biopsy with immunocytologic and flow cytometric methods. Notably, except in the head and neck area, open biopsy remains the best option when lymphoma is suspected or when inconclusive results of previous fine needle aspiration cytology or core needle biopsy are obtained. The incidence of malignant lymphadenopathy varies with its location and the various diagnostic strategies. In metastatic lymphadenopathy of unknown primary origin, European Society for Medical Oncology (ESMO) guidelines and modern methods like next-generation sequencing (NGS) may help to manage such complex cases.
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Affiliation(s)
- Ivana Hanzalova
- Department of Surgery, University Hospital and Lausanne University, Lausanne, Switzerland
| | - Maurice Matter
- Department of Surgery, University Hospital and Lausanne University, Lausanne, Switzerland
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Currie RV, Durand CJ, Bond J. Reducing the incidence of problematic seroma formation and skin necrosis post-lymphadenectomy: Triple action of topical tranexamic acid, negative pressure wound therapy, and prolonged drainage. J Plast Reconstr Aesthet Surg 2024; 94:54-61. [PMID: 38759512 DOI: 10.1016/j.bjps.2024.04.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Axillary and inguinal lymph node dissections are commonly associated with complications that often require additional interventions. METHODS Patients who underwent axillary or inguinal lymphadenectomy via standard procedures were compared to an intervention cohort of patients who underwent axillary or inguinal lymphadenectomy with the use of topical tranexamic acid (TXA) to the wound cavity, a PICO (Smith&Nephew UK) closed-incision negative pressure dressing, and discharged early with a drain in-situ. RESULTS Seventy-six patients in the control group (mean age 65.8 years, mean BMI 28.4 kg/m2) underwent open lymphadenectomy without topical TXA and a simple dressing. Seventy-eight patients were included in the intervention group (mean age 67.1 years, mean BMI 28.5 kg/m2). Patients in the intervention group had an inpatient stay of mean 5.6 days fewer than those in the control group (CI 3.09-5.31; p < .0001), an estimated saving to the healthcare trust of £ 3046.40 (US$3723.61) per patient in "bed days." They had longer drain duration (mean 15 days vs. 8.3 days); however, they had a statistically significant lower risk of seroma formation requiring drainage (6.4% vs. 21%; p = .009), and skin necrosis (0% vs. 6.6%; p = .027). They also had a lower risk of infection (17% vs. 29%), wound dehiscence (15% vs. 25%), and readmission (7.7% vs. 14%), although they were not statistically significant. Patients in the control group were more likely to receive antibiotics as inpatients (51% vs. 7.7%; p < .00001) and on discharge (24% vs. 5%; p < .0011) than those in the intervention group. CONCLUSIONS Topical TXA, PICO dressing, and early discharge with a drain following lymphadenectomy results in a reduced rate of complications.
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Affiliation(s)
- Rachel V Currie
- Regional Department of Maxillofacial and Plastic Surgery, Ulster Hospital, Upper Newtownards Road, Dundonald, Belfast BT16 1RH, Northern Ireland.
| | - Ciaran J Durand
- Regional Department of Maxillofacial and Plastic Surgery, Ulster Hospital, Upper Newtownards Road, Dundonald, Belfast BT16 1RH, Northern Ireland
| | - Jeremy Bond
- Regional Department of Maxillofacial and Plastic Surgery, Ulster Hospital, Upper Newtownards Road, Dundonald, Belfast BT16 1RH, Northern Ireland
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De Martin A, Stanossek Y, Pikor NB, Ludewig B. Protective fibroblastic niches in secondary lymphoid organs. J Exp Med 2024; 221:e20221220. [PMID: 38038708 PMCID: PMC10691961 DOI: 10.1084/jem.20221220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023] Open
Abstract
Fibroblastic reticular cells (FRCs) are specialized fibroblasts of secondary lymphoid organs that provide the structural foundation of the tissue. Moreover, FRCs guide immune cells to dedicated microenvironmental niches where they provide lymphocytes and myeloid cells with homeostatic growth and differentiation factors. Inflammatory processes, including infection with pathogens, induce rapid morphological and functional adaptations that are critical for the priming and regulation of protective immune responses. However, adverse FRC reprogramming can promote immunopathological tissue damage during infection and autoimmune conditions and subvert antitumor immune responses. Here, we review recent findings on molecular pathways that regulate FRC-immune cell crosstalk in specialized niches during the generation of protective immune responses in the course of pathogen encounters. In addition, we discuss how FRCs integrate immune cell-derived signals to ensure protective immunity during infection and how therapies for inflammatory diseases and cancer can be developed through improved understanding of FRC-immune cell interactions.
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Affiliation(s)
- Angelina De Martin
- Institute of Immunobiology, Medical Research Center, Kantonsspital St.Gallen, St.Gallen, Switzerland
| | - Yves Stanossek
- Institute of Immunobiology, Medical Research Center, Kantonsspital St.Gallen, St.Gallen, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St.Gallen, St.Gallen, Switzerland
| | - Natalia Barbara Pikor
- Institute of Immunobiology, Medical Research Center, Kantonsspital St.Gallen, St.Gallen, Switzerland
- Institute of Microbiology, ETH Zurich, Zurich, Switzerland
| | - Burkhard Ludewig
- Institute of Immunobiology, Medical Research Center, Kantonsspital St.Gallen, St.Gallen, Switzerland
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Ishi Y, Omotehara T, Wu X, Kuramasu M, Kawata S, Itoh M. Distribution of Contractile Structures in a Mouse and Human Lymph Node Associated with Lymph Flow. Acta Histochem Cytochem 2023; 56:137-144. [PMID: 38318104 PMCID: PMC10838635 DOI: 10.1267/ahc.23-00054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/28/2023] [Indexed: 02/07/2024] Open
Abstract
Lymph nodes have contractile structures, but their distribution in a lymph node has been less considered in terms of facilitation of lymph flow. Axillary, inguinal, and mesenteric lymph nodes were collected from mice and human cadavers, and their sections were immunostained for alpha-smooth muscle actin (αSMA) and high molecular weight caldesmon (H-caldesmon). The αSMA-positive cells were localized in the capsule beneath the ceiling epithelium on the afferent side in both mice and humans. We found an additional layer of the αSMA-positive cells in the human lymph node, surrounding the inner layer perpendicularly. H-caldesmon was expressed only in these cells of the outer layer. In some human lymph nodes highly containing fat tissue in the medulla, the capsule disappeared on the efferent side, resulting in a disrupted sinusoidal lymph pathway. These findings suggest that human lymph nodes have additional smooth muscles in the outer region of the capsule to facilitate lymph flow. The αSMA-positive cells in the outer and inner layers of human lymph nodes probably have different functions in contraction. The presence of lipomatosis in a human lymph node will reduce its contribution to the lymph flow.
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Affiliation(s)
- Yasuhisa Ishi
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan
| | - Takuya Omotehara
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan
- Department of Anatomy and Life Structure, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Xi Wu
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan
| | - Miyuki Kuramasu
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan
| | - Shinichi Kawata
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan
| | - Masahiro Itoh
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan
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5
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Horvat N, Causa Andrieu P, Meier A, Ji X, Lakhman Y, Soslow R, Allison D, Gangai N, Rodriguez L, Kattan MW, Chi DS, Hricak H. A preoperative nomogram incorporating CT to predict the probability of ovarian clear cell carcinoma. Gynecol Oncol 2023; 176:90-97. [PMID: 37478617 PMCID: PMC10529038 DOI: 10.1016/j.ygyno.2023.06.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVES To evaluate clinical, laboratory, and radiological variables from preoperative contrast-enhanced computed tomography (CECT) for their ability to distinguish ovarian clear cell carcinoma (OCCC) from non-OCCC and to develop a nomogram to preoperatively predict the probability of OCCC. METHODS This IRB-approved, retrospective study included consecutive patients who underwent surgery for an ovarian tumor from 1/1/2000 to 12/31/2016 and CECT of the abdomen and pelvis ≤90 days before primary debulking surgery. Using a standardized form, two experienced oncologic radiologists independently analyzed imaging features and provided a subjective 5-point impression of the probability of the histological diagnosis. Nomogram models incorporating clinical, laboratory, and radiological features were created to predict histological diagnosis of OCCC over non-OCCC. RESULTS The final analysis included 533 patients with surgically confirmed OCCC (n = 61) and non-OCCC (n = 472); history of endometriosis was more often found in patients with OCCC (20% versus 3.6%; p < 0.001), while CA-125 was significantly higher in patients with non-OCCC (351 ng/mL versus 70 ng/mL; p < 0.001). A nomogram model incorporating clinical (age, history of endometriosis and adenomyosis), laboratory (CA-125) and imaging findings (peritoneal implant distribution, morphology, laterality, and diameter of ovarian lesion and of the largest solid component) had an AUC of 0.9 (95% CI: 0.847, 0.949), which was comparable to the AUCs of the experienced radiologists' subjective impressions [0.8 (95% CI: 0.822, 0.891) and 0.9 (95% CI: 0.865, 0.936)]. CONCLUSIONS A presurgical nomogram model incorporating readily accessible clinical, laboratory, and CECT variables was a powerful predictor of OCCC, a subtype often requiring a distinctive treatment approach.
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Affiliation(s)
- Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, NY, New York 10065, USA
| | - Pamela Causa Andrieu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, NY, New York 10065, USA
| | - Andreas Meier
- Department of Radiology, University Hospital of Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Xinge Ji
- Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, NY, New York 10065, USA
| | - Robert Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, NY, New York 10065, USA
| | - Douglas Allison
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, NY, New York 10065, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, NY, New York 10065, USA
| | - Lee Rodriguez
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, NY, New York 10065, USA
| | - Michael W Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Dennis S Chi
- Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, NY, New York 10065, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, NY, New York 10065, USA.
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Lipid nanoparticles technology in vaccines: Shaping the future of prophylactic medicine. Colloids Surf B Biointerfaces 2023; 222:113111. [PMID: 36586237 DOI: 10.1016/j.colsurfb.2022.113111] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/07/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
Throughout decades, the intrinsic power of the immune system to fight pathogens has inspired researchers to develop techniques that enable the prevention or treatment of infections via boosting the immune response against the target pathogens, which has led to the evolution of vaccines. The recruitment of Lipid nanoparticles (LNPs) as either vaccine delivery platforms or immunogenic modalities has witnessed a breakthrough recently, which has been crowned with the development of effective LNPs-based vaccines against COVID-19. In the current article, we discuss some principles of such a technology, with a special focus on the technical aspects from a translational perspective. Representative examples of LNPs-based vaccines against cancer, COVID-19, as well as other infectious diseases, autoimmune diseases, and allergies are highlighted, considering the challenges and promises. Lastly, the key features that can improve the clinical translation of this area of endeavor are inspired.
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Qin L, Zhao C, Wang H, Yang J, Chen L, Su X, Wei L, Zhang T, Li J, Jian C, Hu N, Huang W. Detection of inguinal lymph nodes is promising for the diagnosis of periprosthetic joint infection. Front Cell Infect Microbiol 2023; 13:1129072. [PMID: 37187468 PMCID: PMC10175641 DOI: 10.3389/fcimb.2023.1129072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Background Localized inguinal lymphadenopathy often represents lower extremity pathogen infection, while normalized lymphadenopathy is associated with infection regression. We hypothesized that inguinal lymph nodes (LNs) were enlarged in Periprosthetic Joint Infection (PJI) patients and that normalized inguinal LNs would be a promising way to determine the timing of reimplantation. Methods We prospectively enrolled 176 patients undergoing primary and revision hip or knee arthroplasty. All patients underwent ultrasound examination of inguinal LNs preoperatively. The diagnostic value of inguinal LNs in PJI was evaluated by the receiver operating characteristic (ROC) curve. Results The median level of inguinal LNs was 26mm in the revision for PJI group compared with 12 mm in the aseptic revision group (p< 0.0001). The size of the inguinal LNs well distinguishes PJI from aseptic failure (AUC= 0.978) compare with ESR (AUC= 0.707) and CRP (AUC= 0.760). A size of 19mm was determined as the optimal threshold value of the inguinal LNs for the diagnosis of PJI, with a sensitivity of 92% and specificity of 96%. Conclusion Ultrasonic analysis of inguinal LNs is a valuable piece of evidence for the diagnosis of PJI and evaluation of persistent infection.
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Affiliation(s)
- Leilei Qin
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopedic Laboratory, Chongqing Medical University, Chongqing, China
| | - Chen Zhao
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopedic Laboratory, Chongqing Medical University, Chongqing, China
| | - Hai Wang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Orthopaedics, Fuling Central Hospital Affiliated of Chongqing University, Chongqing, China
| | - Jianye Yang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopedic Laboratory, Chongqing Medical University, Chongqing, China
| | - Li Chen
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopedic Laboratory, Chongqing Medical University, Chongqing, China
| | - Xudong Su
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopedic Laboratory, Chongqing Medical University, Chongqing, China
| | - Li Wei
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopedic Laboratory, Chongqing Medical University, Chongqing, China
| | - Tao Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopedic Laboratory, Chongqing Medical University, Chongqing, China
| | - Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Changchun Jian
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Orthopedics, Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Ning Hu
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopedic Laboratory, Chongqing Medical University, Chongqing, China
- *Correspondence: Ning Hu, ; Wei Huang,
| | - Wei Huang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopedic Laboratory, Chongqing Medical University, Chongqing, China
- *Correspondence: Ning Hu, ; Wei Huang,
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Tavaré R, Danton M, Giurleo JT, Makonnen S, Hickey C, Arnold TC, Kelly MP, Fredriksson F, Bruestle K, Hermann A, Ullman E, Edelmann KH, Potocky T, Dudgeon D, Bhatt NB, Doubrovin M, Barry T, Kyratsous CA, Gurer C, Tu N, Gartner H, Murphy A, Macdonald LE, Popke J, Mintz A, Griesemer A, Olson WC, Thurston G, Ma D, Kirshner JR. Immuno-PET Monitoring of Lymphocytes Using the CD8-Specific Antibody REGN5054. Cancer Immunol Res 2022; 10:1190-1209. [PMID: 35895745 PMCID: PMC9541172 DOI: 10.1158/2326-6066.cir-21-0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/11/2021] [Accepted: 07/26/2022] [Indexed: 11/16/2022]
Abstract
Assessment of immune-cell subsets within the tumor immune microenvironment is a powerful approach to better understand cancer immunotherapy responses. However, the use of biopsies to assess the tumor immune microenvironment poses challenges, including the potential for sampling error, restricted sampling over time, and inaccessibility of some tissues/organs, as well as the fact that single biopsy analyses do not reflect discordance across multiple intrapatient tumor lesions. Immuno-positron emission tomography (PET) presents a promising translational imaging approach to address the limitations and assess changes in the tumor microenvironment. We have developed 89Zr-DFO-REGN5054, a fully human CD8A-specific antibody conjugate, to assess CD8+ tumor-infiltrating lymphocytes (TIL) pre- and posttherapy. We used multiple assays, including in vitro T-cell activation, proliferation, and cytokine production, and in vivo viral clearance and CD8 receptor occupancy, to demonstrate that REGN5054 has minimal impact on T-cell activity. Preclinical immuno-PET studies demonstrated that 89Zr-DFO-REGN5054 specifically detected CD8+ T cells in lymphoid tissues of CD8-genetically humanized immunocompetent mice (VelociT mice) and discerned therapy-induced changes in CD8+ TILs in two models of response to a CD20xCD3 T-cell activating bispecific antibody (REGN1979, odronextamab). Toxicology studies in cynomolgus monkeys showed no overt toxicity, and immuno-PET imaging in cynomolgus monkeys demonstrated dose-dependent clearance and specific targeting to lymphoid tissues. This work supports the clinical investigation of 89Zr-DFO-REGN5054 to monitor T-cell responses in patients undergoing cancer immunotherapy.
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Affiliation(s)
- Richard Tavaré
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, 10591, USA
| | | | | | | | - Carlos Hickey
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, 10591, USA
| | - Tomas C Arnold
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, 10591, USA
| | - Marcus P Kelly
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, 10591, USA
| | - Fanny Fredriksson
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, 10032, USA
- Department of Surgery, Columbia University Medical Center, New York, 10032, USA
| | - Karina Bruestle
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, 10032, USA
- Department of Surgery, Columbia University Medical Center, New York, 10032, USA
| | - Aynur Hermann
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, 10591, USA
| | - Erica Ullman
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, 10591, USA
| | | | - Terra Potocky
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, 10591, USA
| | - Drew Dudgeon
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, 10591, USA
| | - Nikunj B Bhatt
- Columbia University PET Center, Department of Radiology, Columbia University Medical Center, New York, NY, 10032, USA
| | - Mikhail Doubrovin
- Columbia University PET Center, Department of Radiology, Columbia University Medical Center, New York, NY, 10032, USA
| | - Thomas Barry
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, 10591, USA
| | | | - Cagan Gurer
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, 10591, USA
| | - Naxin Tu
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, 10591, USA
| | - Hans Gartner
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, 10591, USA
| | - Andrew Murphy
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, 10591, USA
| | | | - Jon Popke
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, 10591, USA
| | - Akiva Mintz
- Columbia University PET Center, Department of Radiology, Columbia University Medical Center, New York, NY, 10032, USA
| | - Adam Griesemer
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, 10032, USA
- Department of Surgery, Columbia University Medical Center, New York, 10032, USA
| | | | - Gavin Thurston
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, 10591, USA
| | - Dangshe Ma
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, 10591, USA
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What's in a node? The clinical and radiologic significance of Virchow's node. Abdom Radiol (NY) 2022; 47:2244-2253. [PMID: 35316379 DOI: 10.1007/s00261-022-03487-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 11/01/2022]
Abstract
In 1848, Rudolf Ludwig Karl Virchow described an association of left supraclavicular lymphadenopathy with abdominal malignancy. The left supraclavicular lymph node later became commonly referred to as Virchow's node. Charles-Emile Troisier went on to describe the physical exam finding of an enlarged left supraclavicular lymph node, later termed Troisier's sign. Subsequent studies confirmed a predilection of abdominal and pelvic malignancies to preferentially metastasize to the left supraclavicular node. Identification of a pathologically enlarged left supraclavicular node raises the suspicion for abdominopelvic malignancy, particularly in the absence of right supraclavicular lymphadenopathy, and provides a safe and easy target for biopsy. Supraclavicular lymph nodes also represent a great target for diagnosis of metastatic thoracic malignancies, although thoracic malignancies can involve either right or left supraclavicular nodes and do not show a predilection for either. This article presents a review of the history, anatomy, pathophysiology, clinical significance, radiological appearance, and biopsy of Virchow's node. Key points are illustrated with relevant cases.
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10
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Shinagare AB, Sadowski EA, Park H, Brook OR, Forstner R, Wallace SK, Horowitz JM, Horowitz N, Javitt M, Jha P, Kido A, Lakhman Y, Lee SI, Manganaro L, Maturen KE, Nougaret S, Poder L, Rauch GM, Reinhold C, Sala E, Thomassin-Naggara I, Vargas HA, Venkatesan A, Nikolic O, Rockall AG. Ovarian cancer reporting lexicon for computed tomography (CT) and magnetic resonance (MR) imaging developed by the SAR Uterine and Ovarian Cancer Disease-Focused Panel and the ESUR Female Pelvic Imaging Working Group. Eur Radiol 2022; 32:3220-3235. [PMID: 34846566 PMCID: PMC9516633 DOI: 10.1007/s00330-021-08390-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/23/2021] [Accepted: 10/04/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Imaging evaluation is an essential part of treatment planning for patients with ovarian cancer. Variation in the terminology used for describing ovarian cancer on computed tomography (CT) and magnetic resonance (MR) imaging can lead to ambiguity and inconsistency in clinical radiology reports. The aim of this collaborative project between Society of Abdominal Radiology (SAR) Uterine and Ovarian Cancer (UOC) Disease-focused Panel (DFP) and the European Society of Uroradiology (ESUR) Female Pelvic Imaging (FPI) Working Group was to develop an ovarian cancer reporting lexicon for CT and MR imaging. METHODS Twenty-one members of the SAR UOC DFP and ESUR FPI working group, one radiology clinical fellow, and two gynecologic oncology surgeons formed the Ovarian Cancer Reporting Lexicon Committee. Two attending radiologist members of the committee prepared a preliminary list of imaging terms that was sent as an online survey to 173 radiologists and gynecologic oncologic physicians, of whom 67 responded to the survey. The committee reviewed these responses to create a final consensus list of lexicon terms. RESULTS An ovarian cancer reporting lexicon was created for CT and MR Imaging. This consensus-based lexicon has 6 major categories of terms: general, adnexal lesion-specific, peritoneal carcinomatosis-specific, lymph node-specific, metastatic disease -specific, and fluid-specific. CONCLUSIONS This lexicon for CT and MR imaging evaluation of ovarian cancer patients has the capacity to improve the clarity and consistency of reporting disease sites seen on imaging. KEY POINTS • This reporting lexicon for CT and MR imaging provides a list of consensus-based, standardized terms and definitions for reporting sites of ovarian cancer on imaging at initial diagnosis or follow-up. • Use of standardized terms and morphologic imaging descriptors can help improve interdisciplinary communication of disease extent and facilitate optimal patient management. • The radiologists should identify and communicate areas of disease, including difficult to resect or potentially unresectable disease that may limit the ability to achieve optimal resection.
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Affiliation(s)
- Atul B Shinagare
- Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Elizabeth A Sadowski
- Departments of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI, 53792-3252, USA
| | - Hyesun Park
- Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Olga R Brook
- Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Boston, MA, 02215, USA
| | - Rosemarie Forstner
- Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Austria
| | - Sumer K Wallace
- Division of Gynecologic Oncology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave. H4/664A, Madison, WI, 53792, USA
| | - Jeanne M Horowitz
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair, Chicago, IL, 60611, USA
| | - Neil Horowitz
- Division of Gynecologic Oncology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Marcia Javitt
- Medical Imaging, Rambam Health Care Campus, Haifa, Israel
| | - Priyanka Jha
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, Box 0628, San Francisco, CA, 94143-0628, USA
| | - Aki Kido
- Department of Diagnostic Radiology and Nuclear Medicine, Kyoto University Hospital, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto City, Kyoto, 6068507, Japan
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, 10065, USA
| | - Susanna I Lee
- Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, V.le Regina Elena, 324 00161, Rome, Italy
| | - Katherine E Maturen
- Department of Radiology and Obstetrics and Gynecology, University of Michigan Hospitals, 1500 E Med Ctr Dr, Ann Arbor, MI, 48109, USA
| | | | - Liina Poder
- Department of Radiology and Biomedical Imaging, Obstetrics, Gynecology and Reproductive Sciences, UCSF, 505 Parnassus Ave, L-374, San Francisco, CA, 94143-0628, USA
| | - Gaiane M Rauch
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Caroline Reinhold
- Augmented Intelligence & Precision Health Laboratory of the Research Institute of McGill University Health Centre, McGill University, Montreal, Canada, 1001 Decarie boul., Montreal, Quebec, H4A 3J1, Canada
| | - Evis Sala
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
| | - Isabelle Thomassin-Naggara
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Service d'Imagerie, 4 rue de la Chine, 75020, Paris, France
| | - Herbert Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, 10065, USA
| | - Aradhana Venkatesan
- Division of Diagnostic Imaging, Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., FCT 15.6074, MSC 1182, Houston, TX, 77030, USA
| | - Olivera Nikolic
- Clinical Center of Vojvodina, Center of Radiology, Faculty of Medicine, University of Novi Sad, 1-9 Hajduk Veljkova str. 21000, Novi Sad, Serbia
| | - Andrea G Rockall
- Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, ICTEM Building, Du Cane Rd, London, W12 0NN, UK
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Affiliation(s)
| | - John Pascoe
- Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Joseph John
- Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Tom Coats
- Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
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12
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Patel KN, Bhirud C, Dipin J, Nandy K, Venugopal V, Salunke A, Pandya SJ. A proposed Clino-radio-pathological Risk Scoring System (CRiSS) for prediction and management of inguinal lymph-nodes metastasis in squamous cell carcinoma of the penis. Surg Oncol 2021; 36:147-152. [PMID: 33421656 DOI: 10.1016/j.suronc.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To develop a risk scoring system for prediction of inguinal lymph-node involvement and to suggest a management strategy according to the risk groups based on clinical, radiological and pathological parameters in squamous cell carcinoma (SCC) of penis. MATERIALS AND METHODS A retrospective analysis of all patients of SCC penis from 2014 to 2020 at our institute was done. The patients were divided into derivation cohort (2014 to 2019) and validation cohort (2019 to 2020). A total of 10 predictors were analysed in univariate analysis and those found significant were further subjected to multivariate analysis to derive regression coefficient for each. CRiSS scores were assigned based on the coefficients and three groups were created which were correlated with nodal metastasis. The predictive accuracy of the model was assessed by ROC analysis of the derivation cohort and validation cohort. RESULTS A total of 102 patients were identified in derivation cohort and 23 patients in validation cohort. Size of the primary >3cm, ulceroinfiltrative growth, involving shaft, ultrasound size of lymph-nodes >1cm, loss of fatty hila, moderate and poor differentiation, and lypmphovascular/perineural invasion were independent predictors of inguinal lymphnode metastasis in multivariate analysis. CRiSS could achieve AUROC of .910 and .887 in derivation and validation cohort respectively. The rate of metastatic lymphadenopathy was 0%, 41.4%, and 89.5% in low, intermediate, and high-risk groups respectively. CONCLUSIONS CRiSS can effectively predict inguinal lymph-node metastasis in SCC penis. We suggest a management strategy based on risk groups that will avoid morbidity of groin dissection in many patients.
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Affiliation(s)
- Keval N Patel
- Consultant Uro Oncologist, Department of Surgical Oncology, The Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India.
| | - Chirag Bhirud
- 2nd-year Resident. Department of Surgical Oncology, The Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India.
| | - J Dipin
- 2nd-year Resident. Department of Surgical Oncology, The Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India.
| | - Kunal Nandy
- 2nd-year Resident. Department of Surgical Oncology, The Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India.
| | - Vivek Venugopal
- 1st-year Resident. Department of Surgical Oncology, The Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India.
| | - Abhijeet Salunke
- Consultant Ortho Oncosurgeon, Department of Surgical Oncology, The Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India.
| | - Shashank J Pandya
- Department of Surgical Oncology, The Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India.
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13
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Marshall K, Nair SM, Willmore KE, Beveridge TS, Power NE. Anatomical characterization of the inguinal lymph nodes using microcomputed tomography to inform radical inguinal lymph node dissections in penile cancer. J Surg Oncol 2020; 122:1785-1790. [PMID: 32914446 DOI: 10.1002/jso.26199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/15/2020] [Accepted: 08/19/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND & OBJECTIVES Radical inguinal lymph node dissections (rILND) for penile cancer risk significant postoperative lymphocele and lymphedema. However, reducing the risk of lymphatic complications is limited by our understanding of lymphatic anatomy. Therefore, this study aims to elucidate the lymphatic anatomy within the current surgical borders of a rILND. METHODS To visualize the position of the lymph nodes, tissue packets excised from the inguinal region of five fresh, male cadavers were imaged using microcomputed tomography (µCT). To standardize the position, rotation and size between specimens, each lymph node packet was aligned using a Generalized Procrustes analysis. RESULTS There was a median of 13.5 lymph nodes (range = 8-18) per packet, with the majority (99%) clustered within a 6 cm radius of the saphenofemoral junction; a region 39%-41% smaller than current surgical borders. No difference existed between the number of nodes between sides, or distribution around the saphenofemoral junction. CONCLUSIONS This study provides the first 3D, in situ, standardized characterization of lymph node anatomy in the inguinal region using µCT. By using knowledge of the normal lymphatic anatomy, this study can help inform the reduction in borders of rILND to limit disruption and ensure a complete lymphadenectomy.
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Affiliation(s)
- Kaitlin Marshall
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, Ontorio, Canada
| | - Shiva M Nair
- Department of Surgery, Urology Division, Schulich School of Medicine & Dentistry, Western University, London, Ontorio, Canada.,Department of Oncology, Surgical Oncology Division, Schulich School of Medicine & Dentistry, Western University, London, Ontorio, Canada
| | - Katherine E Willmore
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, Ontorio, Canada
| | - Tyler S Beveridge
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, Ontorio, Canada
| | - Nicholas E Power
- Department of Surgery, Urology Division, Schulich School of Medicine & Dentistry, Western University, London, Ontorio, Canada.,Department of Oncology, Surgical Oncology Division, Schulich School of Medicine & Dentistry, Western University, London, Ontorio, Canada
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14
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Miao SS, Lu YF, Chen HY, Liu QM, Chen JY, Pan Y, Yu RS. Contrast-enhanced CT imaging for the assessment of lymph node status in patients with colorectal cancer. Oncol Lett 2020; 19:3451-3458. [PMID: 32269618 PMCID: PMC7114938 DOI: 10.3892/ol.2020.11454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 12/12/2019] [Indexed: 12/13/2022] Open
Abstract
The aim of the present study was to identify a novel strategy that predicts the metastatic status of lymph nodes (LNs) in patients diagnosed with colorectal cancer, using detailed characteristics of contrast-enhanced CT scan images. A total of 284 preoperative CT scans derived from patients diagnosed with colorectal cancer at Second Affiliated Hospital, Zhejiang University School of Medicine between January 2013 and July 2018 were retrospectively reviewed. A total of 794 LNs were assessed for size, margins, morphology and subtle internal enhancements in the equilibrium phase. Imaging features were analyzed by two abdominal radiologists (Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine and Departments of Radiology; Shaoxing Second Hospital Departments of Radiology, Shaoxing Second Hospital) in a blind manner. If the conclusions were not concordant, the final score was determined by a senior radiologist who specialized in abdominal radiology for ≥30 years. According to the histopathology results, 27.3% (217/794) of LNs were metastatic (LN+). In addition, LNs >10 mm in size demonstrated sensitivity, specificity, positive predictive values (PPVs) and negative predictive values (NPVs) of 47.0, 80.9, 48.1 and 80.2%, respectively [odds ratio (OR), 3.77; 95% confidence interval (CI), 2.69–5.28]. LNs in the shape of a kidney bean (middle fat depression like kidney) and/or those with an oblong shape were more likely to be metastasis negative LNs (LN-), while lobulated and irregular LNs were more likely to be LN+. In magnified images, internal enhancement characteristics of LN- were defined as homogeneous, spotted, striped and core enhancing. By contrast, rim and heterogeneity enhancement features for LN+ demonstrated sensitivity, specificity, PPVs and NPVs of 46.5, 89.9, 63.5 and 81.7%, respectively (OR, 7.79; 95% CI, 5.33–11.40). The results demonstrated that the internal enhancement features of LNs may be used as a predictor of metastasis. The detailed benign characteristics, such as homogeneity, spotted, striped and core enhancement of LNs may facilitate the identification of LN- in patients with colorectal cancer.
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Affiliation(s)
- Shi-Song Miao
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China.,Department of Radiology, Shaoxing Second Hospital, Shaoxing, Zhejiang 312000, P.R. China
| | - Yuan-Fei Lu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Hai-Yan Chen
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Qing-Meng Liu
- Department of Pathology, Shaoxing Second Hospital, Shaoxing, Zhejiang 312000, P.R. China
| | - Jie-Yu Chen
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Yao Pan
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Ri-Sheng Yu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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15
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Abdominal lymph node size in children at computed tomography. Pediatr Radiol 2020; 50:1263-1270. [PMID: 32507962 PMCID: PMC7399684 DOI: 10.1007/s00247-020-04715-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/23/2020] [Accepted: 05/12/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lymph node enlargement is commonly used to indicate abnormality. OBJECTIVE To evaluate the normal size and prevalence of abdominal lymph nodes in children at CT. MATERIALS AND METHODS In this retrospective study, we included a total of 152 children ages 1-17 years who underwent abdominal CT examination after high-energy trauma. We measured abdominal lymph nodes in five lymph node stations (inguinal, iliac, para-aortic, hepatic and mesenteric). For the largest lymph node in each level, we measured long- and short-axis diameters in both the axial and coronal planes. We then calculated distribution parameters, correlation coefficients between lymph node size and age, and reference intervals. RESULTS The prevalence of detectable lymph nodes was high for the inguinal (100%), iliac (98%), para-aortic (97%) and mesenteric (99%) stations and lower for the hepatic station (32%). Lymph node size showed small to medium significant correlations (ranging from 0.21 to 0.50) with age. When applying the Lugano criteria and RECIST (Response Criteria in Solid Tumors), 29 children (19%) would have had one or more enlarged abdominal lymph nodes. CONCLUSION The results of this study provide normative data of abdominal lymph node size in children. The current adult guidelines for enlarged lymph nodes seem adequate for most children with the exception of young adolescents, in which larger lymph nodes were relatively common, particularly in the inguinal region.
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Hope TA, Gollub MJ, Arya S, Bates DDB, Ganeshan D, Harisinghani M, Jhaveri KS, Kassam Z, Kim DH, Korngold E, Lalwani N, Moreno CC, Nougaret S, Paroder V, Paspulati RM, Golia Pernicka JS, Petkovska I, Pickhardt PJ, Rauch GM, Rosenthal MH, Sheedy SP, Horvat N. Rectal cancer lexicon: consensus statement from the society of abdominal radiology rectal & anal cancer disease-focused panel. Abdom Radiol (NY) 2019; 44:3508-3517. [PMID: 31388697 DOI: 10.1007/s00261-019-02170-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Standardized terminology is critical to providing consistent reports to referring clinicians. This lexicon aims to provide a reference for terminology frequently used in rectal cancer and reflects the consensus of the Society of Abdominal Radiology Disease Focused Panel in Rectal cancer. This lexicon divided the terms into the following categories: primary tumor staging, nodal staging, treatment response, anal canal anatomy, general anatomy, and treatments.
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Affiliation(s)
- Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA, 94143, USA.
- Department of Radiology, San Francisco VA Medical Center, San Francisco, CA, USA.
- UCSF Helen, Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Kartik S Jhaveri
- University of Toronto University Health Network, Toronto, ON, Canada
| | - Zahra Kassam
- Schulich School of Medicine, Western University, London, ON, Canada
| | - David H Kim
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | - Neeraj Lalwani
- Department of Radiology, Section of Abdominal Imaging, Wake Forest University and Baptist Medical Center, Winston-Salem, NC, USA
| | | | - Stephanie Nougaret
- Montpellier Cancer Research Institute, Montpellier, France
- Department of Radiology, Montpellier Cancer Institute, INSERM, U1194, University of Montpellier, Montpellier, France
| | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raj M Paspulati
- Department of Radiology, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | | | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Perry J Pickhardt
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Gaiane M Rauch
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael H Rosenthal
- Harvard Medical School, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Natally Horvat
- Department of Radiology, Hospital Sirio-Libanes, São Paulo, São Paulo, Brazil
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17
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Varkhede N, Forrest L. Understanding the Monoclonal Antibody Disposition after Subcutaneous Administration using a Minimal Physiologically based Pharmacokinetic Model. JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES 2019; 21:130s-148s. [PMID: 30011390 DOI: 10.18433/jpps30028] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE Monoclonal antibodies (mAbs) are commonly administered by subcutaneous (SC) route. However, bioavailability is often reduced after SC administration. In addition, the sequential transfer of mAbs through the SC tissue and lymphatic system is not completely understood. Therefore, major objectives of this study were a) To understand absorption of mAbs via the lymphatic system after SC administration using physiologically based pharmacokinetic (PBPK) modeling, and b) to demonstrate application of the model for prediction of SC pharmacokinetics (PK) of mAbs. METHODS A minimal PBPK model was constructed using various physiological parameters related to the SC injection site and lymphatic system. The remainder of the body organs were represented using a 2-compartment model (central and peripheral compartments), with parameters derived from available intravenous (IV) PK data. The IV and SC clinical PK data of a total of 10 mAbs were obtained from literature. The SC PK data were used to estimate the lymphatic trunk-lymph node (LN) clearance. RESULTS The mean estimated lymphatic trunk-LN clearance obtained from 37 SC PK profiles of mAbs was 0.00213 L/h (0.001332 to 0.002928, 95% confidence intervals). The estimated lymphatic trunk-LN clearance was greater for the mAbs with higher isoelectric point (pI). In addition, the estimated clearance increased with decrease in the bioavailability. CONCLUSION The minimal PBPK model identified SC injection site lymph flow, afferent and efferent lymph flows, and volumes associated with the SC injection site, lymphatic capillaries and lymphatic trunk-LN as important physiological parameters governing the absorption of mAbs after SC administration. The model may be used to predict PK of mAbs using the relationship of lymphatic trunk-LN clearance and the pI. In addition, the model can be used as a bottom platform to incorporate SC and lymphatic in vitro clearance data for mAb PK prediction in the future.
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Affiliation(s)
- Ninad Varkhede
- Department of Pharmaceutical Chemistry, The University of Kansas, Lawrence, Kansas 66047, USA
| | - Laird Forrest
- Department of Pharmaceutical Chemistry, The University of Kansas, Lawrence, Kansas 66047, USA
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18
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Revzin MV, Ersahin D, Israel GM, Kirsch JD, Mathur M, Bokhari J, Scoutt LM. US of the Inguinal Canal: Comprehensive Review of Pathologic Processes with CT and MR Imaging Correlation. Radiographics 2016; 36:2028-2048. [PMID: 27715712 DOI: 10.1148/rg.2016150181] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ultrasonography (US) has a fundamental role in the initial examination of patients who present with symptoms indicating abnormalities of the inguinal canal (IC), an area known for its complex anatomy. A thorough understanding of the embryologic and imaging characteristics of the contents of the IC is essential for any general radiologist. Moreover, an awareness of the various pathologic conditions that can affect IC structures is crucial to preventing misdiagnoses and ensuring optimal patient care. Early detection of IC abnormalities can reduce the risk of morbidity and mortality and facilitate proper treatment. Abnormalities may be related to increased intra-abdominal pressure, which can result in development of direct inguinal hernias and varicoceles, or to congenital anomalies of the processus vaginalis, which can result in development of indirect hernias and hydroceles. US is also helpful in assessing postoperative complications of hernia repair, such as hematoma, seroma, abscess, and hernia recurrence. In addition, it is often the modality initially used to detect neoplasms arising from or invading the IC. US is an important tool in the examination of patients suspected of having undescended testes or posttraumatic testicular retraction and is essential for the examination of patients suspected of having torsion or infectious inflammatory conditions of the spermatic cord. Online supplemental material is available for this article. ©RSNA, 2016.
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Affiliation(s)
- Margarita V Revzin
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Devrim Ersahin
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Gary M Israel
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Jonathan D Kirsch
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Mahan Mathur
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Jamal Bokhari
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Leslie M Scoutt
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
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