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European Journal of Medical Research Dec 2023The main problem of positron emission tomography/computed tomography (PET/CT) for lymph node (LN) staging is the high false positive rate (FPR). Thus, we aimed to... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The main problem of positron emission tomography/computed tomography (PET/CT) for lymph node (LN) staging is the high false positive rate (FPR). Thus, we aimed to explore a clinico-biological-radiomics (CBR) model via machine learning (ML) to reduce FPR and improve the accuracy for predicting the hypermetabolic mediastinal-hilar LNs status in lung cancer than conventional PET/CT.
METHODS
A total of 260 lung cancer patients with hypermetabolic mediastinal-hilar LNs (SUVmax ≥ 2.5) were retrospectively reviewed. Patients were treated with surgery with systematic LN resection and pathologically divided into the LN negative (LN-) and positive (LN +) groups, and randomly assigned into the training (n = 182) and test (n = 78) sets. Preoperative CBR dataset containing 1738 multi-scale features was constructed for all patients. Prediction models for hypermetabolic LNs status were developed using the features selected by the supervised ML algorithms, and evaluated using the classical diagnostic indicators. Then, a nomogram was developed based on the model with the highest area under the curve (AUC) and the lowest FPR, and validated by the calibration plots.
RESULTS
In total, 109 LN- and 151 LN + patients were enrolled in this study. 6 independent prediction models were developed to differentiate LN- from LN + patients using the selected features from clinico-biological-image dataset, radiomics dataset, and their combined CBR dataset, respectively. The DeLong test showed that the CBR Model containing all-scale features held the highest predictive efficiency and the lowest FPR among all of established models (p < 0.05) in both the training and test sets (AUCs of 0.90 and 0.89, FPRs of 12.82% and 6.45%, respectively) (p < 0.05). The quantitative nomogram based on CBR Model was validated to have a good consistency with actual observations.
CONCLUSION
This study presents an integrated CBR nomogram that can further reduce the FPR and improve the accuracy of hypermetabolic mediastinal-hilar LNs evaluation than conventional PET/CT in lung cancer, thereby greatly reducing the risk of overestimation and assisting for precision treatment.
Topics: Humans; Lung Neoplasms; Positron Emission Tomography Computed Tomography; Fluorodeoxyglucose F18; Retrospective Studies; Lymphatic Metastasis; Neoplasm Staging; Lymph Nodes; Machine Learning
PubMed: 38042812
DOI: 10.1186/s40001-023-01497-6 -
Archives of Pathology & Laboratory... Mar 2024Immunohistochemistry has become a valuable ancillary tool for the accurate classification of pleuropulmonary and mediastinal neoplasms necessary for therapeutic... (Review)
Review
CONTEXT.—
Immunohistochemistry has become a valuable ancillary tool for the accurate classification of pleuropulmonary and mediastinal neoplasms necessary for therapeutic decisions and predicting prognostic outcome. Diagnostic accuracy has significantly improved because of the continuous discoveries of tumor-associated biomarkers and the development of effective immunohistochemical panels.
OBJECTIVE.—
To increase the accuracy of diagnosis and classify pleuropulmonary neoplasms through immunohistochemistry.
DATA SOURCES.—
Literature review and the author's research data and personal practice experience.
CONCLUSIONS.—
This review article highlights that appropriately selecting immunohistochemical panels enables pathologists to effectively diagnose most primary pleuropulmonary neoplasms and differentiate primary lung tumors from a variety of metastatic tumors to the lung. Knowing the utilities and pitfalls of each tumor-associated biomarker is essential to avoid potential diagnostic errors.
Topics: Humans; Mediastinal Neoplasms; Immunohistochemistry; Biomarkers, Tumor; Prognosis; Diagnosis, Differential
PubMed: 37406295
DOI: 10.5858/arpa.2022-0483-RA -
Thoracic Cancer Dec 2020Endosonography is accepted as the initial procedure for mediastinal staging in patients with suspected non-small cell lung cancer (NSCLC). However, the diagnostic value...
BACKGROUND
Endosonography is accepted as the initial procedure for mediastinal staging in patients with suspected non-small cell lung cancer (NSCLC). However, the diagnostic value of different staging methods in specific subgroups is unclear. The purpose of this study was to assess the performance and outcome of mediastinal staging in lung cancer in a general teaching hospital.
METHODS
The records of 870 consecutive patients with potentially resectable NSCLC (cT1-3NxM0) were analyzed in a retrospective cohort study between January 2010 and December 2016. Patients were divided into four different groups according to ESTS guidelines. The primary endpoint was the rate of unforeseen mediastinal metastasis in these groups and the sensitivity of different staging methods.
RESULTS
Mediastinal staging was performed in 336 patients of whom 112 (33%) underwent lobectomy. Unforeseen mediastinal metastasis was seen in 10 (9%) patients after negative mediastinal staging. Sensitivity after combined mediastinal staging (endosonography with mediastinoscopy) in the overall group was 94%. In patients without suspected mediastinal lymph nodes but with suspected hilar lymph nodes (N1), or a peripheral tumor >3 cm, sensitivity of endosonography was 33% and mediastinoscopy 75%. Biopsy of at least level 4L, 4R and 7 was taken in 18% of the endosonographies and 58% of the mediastinoscopies.
DISCUSSION
Combined mediastinal staging (endosonography with mediastinoscopy) is reliable with a sensitivity of 94%. However, the diagnostic value of endosonography in patients with suspected hilar lymph nodes or a peripheral tumor >3 cm is questionable, and in these patients, performing direct mediastinoscopy should be considered.
KEY POINTS
SIGNIFICANT FINDINGS OF THIS STUDY: The diagnostic value of endosonography in patients without suspected mediastinal lymph nodes but with potential risk factors (suspected N1 disease or peripheral tumor >3 cm) is questionable. Therefore, mediastinoscopy as the first choice should be considered in these patients. WHAT THIS STUDY ADDS?: Accurate mediastinal nodal staging is essential in patients with suspected NSCLC to avoid unnecessary lobectomy. Detailed knowledge about sensitivity and specificity of mediastinal staging techniques in different patient groups can make a difference.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Female; Humans; Lung Neoplasms; Male; Mediastinum; Middle Aged; Neoplasm Staging; Preoperative Period; Retrospective Studies
PubMed: 33026177
DOI: 10.1111/1759-7714.13673 -
Cancer Radiotherapie : Journal de La... May 2023For treatment of esophageal carcinoma, the optimal postoperative radiotherapy target volume after three-field lymph node dissection (3-FLD) had not been determined. We... (Review)
Review
PURPOSE
For treatment of esophageal carcinoma, the optimal postoperative radiotherapy target volume after three-field lymph node dissection (3-FLD) had not been determined. We analyzed local recurrence pattern of thoracic esophageal carcinoma and risk factors of lymph node recurrence after 3-FLD without prophylactic radiotherapy.
MATERIAL AND METHODS
We reviewed 1282 patients with thoracic esophageal squamous cell carcinoma (ESCC) who were treated with 3-FLD without radiotherapy from 2010 to 2018 and analysed local recurrence patterns and risk factors of lymph node recurrence, in order to provide a reference for determination of the radiotherapy target volume for thoracic ESCC.
RESULTS
The lymph node recurrence accounted for 91.0% of treatment failures. The mediastinal, cervical and abdominal lymph node recurrence accounted for 84.92%, 36.07% and 22.30%, respectively (χ=264.776, P=0.000). The superior, middle and inferior mediastinal lymph node recurrence rates were 67.54%, 27.87% and 0.98%, respectively (χ=313.600, P=0.000). Cervical metastases were significantly associated with N stage and Preoperative cervical lymph node status. Abdominal metastases were significantly associated with the number of preoperative abdominal lymph node metastases (LNM), tumor location and N stage.
CONCLUSIONS
The main pattern of local-regional recurrence might be lymph node metastasis after radical 3-FLD without radiotherapy in esophageal carcinoma. The dangerous lymph node recurrence regions included neck, superior and middle mediastinum. The abdominal areas might be irradiated for lower TEC patients with preoperative abdominal LNM.
Topics: Humans; Esophageal Neoplasms; Esophageal Squamous Cell Carcinoma; Carcinoma, Squamous Cell; Neoplasm Staging; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Esophagectomy; Retrospective Studies; Recurrence; Neoplasm Recurrence, Local
PubMed: 36754752
DOI: 10.1016/j.canrad.2022.09.001 -
Clinical & Translational Oncology :... May 2023To predict treatment-related cardiovascular disease (CVD) and second cancer 30-year absolute mortality risks (AMR) for patients with mediastinal Hodgkin lymphoma in a...
BACKGROUND AND PURPOSE
To predict treatment-related cardiovascular disease (CVD) and second cancer 30-year absolute mortality risks (AMR) for patients with mediastinal Hodgkin lymphoma in a large multicentre radiation oncology network in Ireland.
MATERIAL AND METHODS
This study includes consecutive patients treated for mediastinal lymphoma using chemotherapy and involved site radiotherapy (RT) 2016-2019. Radiation doses to heart, left ventricle, cardiac valves, lungs, oesophagus, carotid arteries and female breasts were calculated. Individual CVD and second cancer AMR were predicted using Irish background population rates and dose-response relationships.
RESULTS
Forty-four patients with Hodgkin lymphoma were identified, 23 females, median age 28 years. Ninety-eight percent received anthracycline, 80% received 4-6 cycles ABVD. Volumetric modulated arc therapy (VMAT) ± deep inspiration breath hold (DIBH) was delivered, median total prescribed dose 30 Gy. Average mean heart dose 9.8 Gy (range 0.2-23.8 Gy). Excess treatment-related mean AMR from CVD was 2.18% (0.79, 0.90, 0.01, 0.13 and 0.35% for coronary disease, heart failure, valvular disease, stroke and other cardiac diseases), 1.07% due to chemotherapy and a further 1.11% from RT. Excess mean AMR for second cancers following RT were: lung cancer 2.20%, breast cancer in females 0.34%, and oesophageal cancer 0.28%.
CONCLUSION
For patients with mediastinal lymphoma excess mortality risks from CVD and second cancers remain clinically significant despite contemporary chemotherapy and photon-RT. Efforts to reduce the toxicity of combined modality treatment, for example, using DIBH, reduced margins and advanced RT, e.g. proton beam therapy, should be continued to further reduce potentially fatal treatment effects.
Topics: Humans; Female; Adult; Radiotherapy, Intensity-Modulated; Hodgkin Disease; Neoplasms, Second Primary; Antineoplastic Combined Chemotherapy Protocols; Breath Holding; Radiotherapy Dosage; Organs at Risk; Bleomycin; Dacarbazine; Doxorubicin; Vinblastine; Heart; Mediastinal Neoplasms; Lymphoma; Cardiovascular Diseases; Radiotherapy Planning, Computer-Assisted
PubMed: 36585562
DOI: 10.1007/s12094-022-03034-z -
Journal of Geriatric Cardiology : JGC Jul 2021Mediastinal neoplasms are rare in the elderly, and clinical suspicion is the first and most important step of differential diagnosis. Mediastinal tumors can be...
Mediastinal neoplasms are rare in the elderly, and clinical suspicion is the first and most important step of differential diagnosis. Mediastinal tumors can be misdiagnosed because their symptoms or signs can overlap with cardiovascular diseases, which have a higher prevalence among the older population. The diagnostic process should be managed with multimodality imaging and clinical judgement. Here, the case of a 74-year-old male patient, who presented with shortness of breath, is examined. A chest X-ray revealed an increased cardiothoracic ratio, and he was diagnosed with hemopericardium following an emergent chest computed tomography. In the echocardiography, it was suspected that a hyperechogenic area adjacent to the heart might be due to a mass, and further examinations confirmed a mediastinal neoplasm. A surgical biopsy was performed, and it was determined to be a mesenchymal tumor. To conclude, clinicians should keep in mind the possibility of paracardiac neoplasm in the elderly, as well as in other age groups, when encountering mediastinal widening so that the patient can be protected from unnecessary interventions such as pericardiocentesis.
PubMed: 34404995
DOI: 10.11909/j.issn.1671-5411.2021.07.007 -
Diagnostic Pathology Oct 2022Thymofibrolipoma has been described as a variant of thymolipoma. To date, 3 cases have been reported, and the lesion have been described to consist of extensive areas of... (Review)
Review
BACKGROUND
Thymofibrolipoma has been described as a variant of thymolipoma. To date, 3 cases have been reported, and the lesion have been described to consist of extensive areas of collagenous tissue interspersed with islands of mature adipose tissue and strands of thymic tissue.
CASE PRESENTATION
A 43-year-old woman had an anterior mediastinal tumor. Macroscopically, the cut surface of the tumor was composed of a yellowish lipomatous component and a uniform whitish fibrous component with elastic stiffness. Microscopically, the tumor was composed of collagenous fibrous tissue with sparse spindle cells, mature adipocytes and strands or islands of thymic tissue. The spindle cells in the fibrous tissue had monoallelic deletion of the 13q14 region and corresponding loss of RB1 and FOXO1A protein expression.
CONCLUSIONS
This case report may strengthen the hypothesis that thymofibrolipoma is a neoplastic lesion and a variant of thymolipoma and that thymofibrolipoma and lipofibroadenoma are different names for the same lesion. The name "lipofibroadenoma" was given to the lesion because of its histological resemblance to fibroadenoma of the mammary gland. However, this name does not reflect the pathogenesis of this lesion, and the name "thymofibrolipoma" would be preferable. It will be necessary to discuss whether lipofibroadenoma should be listed as an independent entity in the WHO classification.
Topics: Adult; Female; Humans; Lipoma; Mediastinal Neoplasms; Mediastinum; Thymus Neoplasms
PubMed: 36224593
DOI: 10.1186/s13000-022-01260-1 -
Multimedia Manual of Cardiothoracic... May 2023Paragangliomas are tumours originating from the autonomic nervous system and rarely occur in the chest. They may manifest through symptoms of excess catecholamine...
Paragangliomas are tumours originating from the autonomic nervous system and rarely occur in the chest. They may manifest through symptoms of excess catecholamine release or due to local compression, can be an incidental finding on a computed tomography/magnetic resonance imaging examination or can be found when screening patients with specific gene mutations. Surgical removal is indicated in case of symptoms, (imminent) compression of vital structures or to prevent progression to malignancy. Resection of a paraganglioma in the middle mediastinum can be challenging. The relationship of the tumour to vital structures and its blood supply determine the surgical access route. In this case report, a large paraganglioma situated in the middle mediastinum is resected. Because of the close relationship to vital structures and the presence of feeding arteries from the aortic arch, a transsternal transpericardial approach is chosen. After a median sternotomy, stepwise dissection between the aorta, superior caval vein and right pulmonary artery and the opening of the posterior pericardium gives access to the middle mediastinum and the area between the tracheal bifurcation and the left atrial roof. These steps can be done without cardiopulmonary bypass. After identification and division of the feeding aortic arch arteries, the highly vascularized tumour can be further dissected and removed.
Topics: Humans; Vena Cava, Superior; Mediastinal Neoplasms; Paraganglioma; Mediastinum; Aorta, Thoracic
PubMed: 37212249
DOI: 10.1510/mmcts.2023.010 -
Drug Discoveries & Therapeutics Nov 2020T-cell acute lymphoblastic lymphoma is a common hematological malignancy of childhood. It can involve the bone marrow, blood, or tissues like the thymus, lymph nodes as...
T-cell acute lymphoblastic lymphoma is a common hematological malignancy of childhood. It can involve the bone marrow, blood, or tissues like the thymus, lymph nodes as well as extra-nodal sites. Two aspects of the disease make early diagnosis critical - the clinically aggressive nature of the neoplasm, and availability of effective chemotherapy against the disease. Diagnosis is largely based on clinical suspicion and confirmation by histopathological examination of the affected tissue. However, biopsy results may not always be helpful in establishing the diagnosis. We describe the case of an 18-year old patient presenting with fever and an anterior mediastinal mass suspected to have a T-cell lymphoma where an initial biopsy from the mass had features of a thymoma. The patient was kept in close follow up for 2 months when there was a recurrence of symptoms and a repeat bone marrow evaluation revealed a T-cell lymphoma.
Topics: Adolescent; Aftercare; Antineoplastic Agents; Biopsy; Biopsy, Fine-Needle; Bone Marrow; Cough; Dyspnea; Fever; Humans; Lymphoma; Male; Mediastinal Neoplasms; Pleural Effusion; Remission Induction; Thymoma; Tomography, X-Ray Computed; Weight Loss
PubMed: 33116034
DOI: 10.5582/ddt.2020.03025 -
Blood Jun 2023
Topics: Humans; Brentuximab Vedotin; Nivolumab; Hodgkin Disease; Immunoconjugates; Mediastinal Neoplasms
PubMed: 36898084
DOI: 10.1182/blood.2022017951