OBJECTIVE: To compare the diagnostic accuracy of Contrast Enhanced Computed Tomography (CECT) compared to conventional imaging modalities and histopathological investigation in cervical lymph node metastasis in adults through a novel meta- analysis.
METHODS: The review protocol is registered under PROSPERO(CRD42021225704) and performed in accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analysis - Diagnostic Test Accuracy (PRISMA- DTA) checklist. Databases like PubMed, Google Scholar, EBSCOhost were searched from 2000 to 2023 to identify the diagnostic potential of CECT in cervical lymph node metastasis of oral carcinoma. True-positive, false-positive, true-negative, false-negative, sensitivity, specificity values were extracted or calculated if not present for each study. Quality of selected studies was evaluated based on Quality assessment of diagnostic accuracy studies (QUADAS)- 2 tool. Meta-analysis was performed in Meta-Disc 1.4 software and Review Manager 5.3 using a bivariate model parameter for the pooled sensitivity and pooled specificity. Additional analysis was performed in terms of positive likelihood ratio (+LR), negative likelihood ratio (-LR), diagnostic odds ratio (DOR) and summary receiver operating characteristics (SROC) with Area Under Curve (AUC) and p<0.05 as statistically significant.
RESULTS: Six studies were included for qualitative synthesis and as well as for meta-analysis. Two studies had high risk of bias while four studies had low risk of bias. 651 patients underwent CECT and were taken for meta-analysis. The meta-analysis revealed that CECT for diagnosing cervical lymph node metastasis had a pooled sensitivity of 71%, pooled specificity of 14% with 60% Area Under Curve (AUC). +LR of 0.84, -LR of 1.36 and DOR of 0.59.
CONCLUSIONS: CECT has an overall fair diagnostic ability and is a valid and reliable tool in diagnosing the target condition overcoming high reliance on master specialized capacity for their execution and understanding like other conventional imaging techniques. CECT can be concluded for secondary level of prevention for cervical node metastasis of oral carcinoma under early diagnosis and prompt treatment. However, further standardized accuracy studies are indicated to improve the overall diagnostic accuracy of CECT.

BACKGROUND: Lung cancer remains the primary cause of cancer-related deaths on a global scale. Surgery is the main therapeutic option for non-small cell lung cancer (NSCLC). However, the optimal surgical approach for lymph node assessment in NSCLC resection remains controversial, and it is still uncertain whether lymph node dissection (LND) is more effective in reducing recurrence and metastasis rates in NSCLC compared with lymph node sampling (LNS). Therefore, we will conduct a meta-analysis to evaluate the recurrence and metastasis of LND versus LNS in patients with NSCLC.
METHODS: This systematic review and meta-analysis will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis: The PRISMA Statement. According to the predefined inclusion criteria, we will conduct a comprehensive search for randomised controlled trials and non-randomised studies examining the recurrence and metastasis of LND compared with LNS in patients with NSCLC. A literature search from inception in PubMed, EMBASE, the Cochrane Library, CNKI, Wanfang, SINOMED, VIP and Web of Science will be done. There will be no limitations on language, and the search will be undertaken on 30 August 2024, with regular search for new studies. Additionally, relevant literature references will be retrieved and hand-searching of pertinent journals will be conducted. The main outcomes include overall recurrence rate, local recurrence rate and distant metastasis rate. The supplementary outcomes encompass the rates of regional recurrence and lymph node metastasis. Two independent reviewers will perform screening, data extraction and quality assessment. Our reviewers will perform subgroup analysis, sensitivity analysis and publication bias analysis to evaluate the heterogeneity and robustness. Review Manager 5.4 will be applied in analysing and synthesising. The Grading of Recommendations Assessment, Development and Evaluation will be used to assess the quality of evidence for the whole study.
BACKGROUND: Ethical approval is dispensable for this study since no private information of the participants will be involved. The findings of the present study will be disseminated through a peer-reviewed journal or conference presentation.
BACKGROUND: The protocol of the systematic review has been registered on Open Science Framework, with a registration doi: https://doi.org/10.17605/OSF.IO/S2FT5.

The treatment of isolated ipsilateral supraclavicular lymph node metastasis for locally advanced breast cancer has always been a controversial issue for breast surgeons. However, with the further understanding of the metastasis and treatment of breast cancer, it is now considered to be a locally advanced disease, and there is a new debate on the treatment of isolated ipsilateral supraclavicular lymph node metastasis. The author reviewed the relevant literature and briefly discussed the clinical significance of supraclavicular lymph node resection in patients with locally advanced breast cancer presenting with isolated ipsilateral supraclavicular lymph node metastasis.

UNASSIGNED: Non-tuberculous mycobacteria (NTM) are a group of mycobacteria that are commonly found in the environment and can cause disease in humans. The symptoms of NTM infection can be similar to those of tuberculosis, making diagnosis challenging. The morbidity associated with NTM is increasing, and clinical management can be challenging.
UNASSIGNED: This report details the case of a 32-year-old male who was found to have multiple enlarged and partially necrotic lymph nodes in the neck, axilla, mediastinum, and retroperitoneum. The causative agent was rapidly identified as Mycobacterium paracondontium through pathogen-targeted sequencing (tNGS). After two weeks of treatment with azithromycin, moxifloxacin, rifabutin, and amikacin, the patient\'s uncomfortable symptoms had resolved, and he is currently undergoing further review.
UNASSIGNED: It is imperative that clinicians remain vigilant for the presence of NTM, particularly those that are rare, given their pervasiveness in the environment. Prompt diagnosis is of paramount importance, and molecular identification techniques represent a crucial tool in this regard. In vitro drug sensitivity testing should be conducted whenever feasible to guarantee the administration of an efficacious treatment regimen.

BACKGROUND: Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. In rare instances, PTC has metastasized to the retropharyngeal and parapharyngeal nodes. This is hypothesized to occur due to an aberrant lymphatic channel or via retrograde lymphatic flow following previous neck dissection.
METHODS: A literature search was conducted with keywords \"parapharyngeal,\" \"retropharyngeal,\" and \"papillary thyroid carcinoma.\"
RESULTS: 46 articles were identified for a total of 135 cases. The most common presenting symptom was lymphadenopathy followed by pharyngeal mass and dyspnea. 38.03 % of patients were asymptomatic. Of cases including initial treatment history, 94.44 % had a history of neck dissection. The transcervical approach was the most utilized to resect the tumors, although in recent years trans-oral robotic surgery (TORS) has also been used.
CONCLUSIONS: PTC metastatic to the retropharyngeal and parapharyngeal nodes is a rare occurrence that can be difficult to diagnose due its indolent nature.

Breast cancer (BC) is one of the most common cancers with rare incidence of possible metastatic disease to the gastrointestinal (GI) tract. Early clinical suspicion is important for a timely referral to gastroenterology and for executing a treatment plan. It is difficult to distinguish primary gastric or colon cancer from metastatic disease, and the diagnosis of metastasis can only be established by pathological and immunohistochemistry analysis. We report an interesting case who had metastatic BC to cervical and axillary lymph nodes and was treated with radiation and endocrine therapy. She remained asymptomatic for years, then was found to have rising tumor markers on regular follow-up visits that led to an extensive workup that was negative for tumor recurrence. Five years after radiation therapy, she developed GI symptoms and was referred for esophagogastroduodenoscopy (EGD) and colonoscopy, revealing extensive GI metastatic disease involving the stomach to the rectum. For a patient with metastatic BC who presents with rising tumor markers or gastric symptoms, it is important to do diagnostic studies to rule out GI metastatic disease when no primary disease is identified in the workup.

BACKGROUND: Castleman\'s disease (CD) is a rare lymphoproliferative, emulating both benign and malignant diseases. The diagnosis of CD is formulated upon the combination of clinical and laboratory criteria and ultimately confirmed by histopathological assessment. Due to its rarity, CD presents a challenge in treatment selection, with available options encompassing surgery, chemotherapy, and autologous stem cell transplantation. However, studies suggest that surgical resection of the lesion is the most effective treatment modality, especially for unicentric CD (UCD).
METHODS: Here, we describe the case of a 25-year-old woman who presented with painless left thigh swelling for 10 wk. She had been following a low-fat diet to lose weight and had normal laboratory results. Magnetic resonance imaging revealed a well-circumscribed, demarcated cystic lesion located in the left inguinal region with eccentrically positioned signal void vascular structures, measuring 4.3 cm × 3 cm × 3.2 cm, likely of lymphoid origin. The patient underwent surgical resection, and the final histopathology showed a vascular proliferation and hyalinization of the vessel walls, along with atretic germinal centers traversed by penetrating vessels, consistent with CD. The patient was discharged home one day after the procedure in good condition, with a follow-up appointment scheduled in our outpatient clinic.
CONCLUSIONS: Although surgical resection is the mainstay for UCD, a multidisciplinary approach is needed due the lack of specific diagnostic features and treatments.

The primary objective of this study was to conduct a comparative analysis of the diagnostic efficacy of [18F]-FDG PET/CT and [18F]-FDG PET/MRI in the detection of breast cancer lymph node metastasis.
We conducted a comprehensive search on PubMed, Embase, and Web of Science databases, encompassing eligible articles until March 2023. The pooled sensitivity and specificity for [18F]-FDG PET/CT and [18F]-FDG PET/MRI have been reported as estimates with 95% Confidence Intervals (CIs) using a bivariate random-effect model. Utilizing the I square (I2) statistic, heterogeneity among pooled studies was evaluated. The quality assessment of the included studies was conducted using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) methodology.
We included 18 studies (2057 patients). The sensitivity, specificity, and AUC (Area Under the Curve) values of [18F]-FDG PET/CT for overall lymph node metastasis in breast cancer have been found to be 0.58 (0.39 - 0.75), 0.83 (0.69-0.92), and 0.79 (0.75-0.82), respectively. Correspondingly, the values for [18F]-FDG PET/MRI were found to be 0.76 (0.60-0.88), 0.85 (0.77-0.91), and 0.89 (0.86-0.91), respectively. The sensitivity, specificity, and AUC values of [18F]-FDG PET/CT for axillary lymph node metastasis in breast cancer were 0.52 (0.37-0.67), 0.84 (0.68-0.92), and 0.73 (0.69-0.76), respectively. Correspondingly, the values for [18F]-FDG PET/MRI were 0.84 (0.76-0.89), 0.87 (0.75-0.94), and 0.86 (0.83-0.89), respectively.
This study has suggested [18F]-FDG PET/MRI to have greater diagnostic power than [18F]-FDG PET/CT in detecting lymph node metastasis in breast cancer. However, the [18F]-FDG PET/MRI results have been obtained from a small sample size study, and more and larger prospective studies are needed for further confirmation on this issue.

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OBJECTIVE: To systematically review and meta-analyze the prognostic significance of lateral lymph node metastasis (LLNM) on pretreatment MRI in patients with rectal cancer who undergo neoadjuvant chemoradiation followed by curative surgical resection without lateral lymph node dissection (LLND).
METHODS: We searched the MEDLINE and EMBASE databases until September 27, 2023, utilizing the following search terms: (rectal OR rectum OR colorectal) AND (lateral OR sidewall) AND (lymph OR node). The QUIPS tool was employed to evaluate methodological quality. We pooled the association between LLNM on pretreatment MRI and outcomes such as local recurrence, distant metastasis, disease-free survival, and overall survival using hazard ratio (HR) and odds ratio (OR) based on random effects model.
RESULTS: We included 9 studies, encompassing 3180 patients. LLNM on pretreatment MRI revealed a significant association with increased local recurrence rates (HR: 4.11; 95 % CI: [1.87, 9.02]) and elevated risks for both disease-free (HR: 1.70; 95 % CI: [1.42, 2.03]) and overall survival (HR: 1.76; 95 % CI: [1.44, 2.15]). As for distant metastasis, our analysis indicated a potential trend towards increased rates, though this did not reach statistical significance (HR: 1.67; 95 % CI: [0.85, 3.27]).
CONCLUSIONS: Our findings underscore the relationship between LLNM and increased local recurrence and compromised disease-free and overall survival. This emphasizes the potential limitations of relying solely on neoadjuvant chemoradiation and highlights the potential need to intensify treatment in select patients.

OBJECTIVE: Endometrial intraepithelial neoplasia (EIN) and atypical hyperplasia (AH) are recognized precursors for endometrial cancer (EC). Most current guidelines do not recommend the routine surgical evaluation of lymph nodes (LN), although recent studies indicate increased use of sentinel lymph node (SLN) biopsy in patients with a preoperative diagnosis of EIN/AH. We aimed to evaluate the rates of positive LN and its effect on the incidence of upstaging of EIN/AH patients, complications, and adjuvant treatment administration.
METHODS: A systematic review and meta-analysis was conducted in the following databases: MEDLINE(R) using the OvidSP interface and PUBMED, Embase, Web of Science, Clinicaltrials.gov and Cochrane Library. Included were studies investigating lymph node evaluation in patients diagnosed with EIN/AH, presenting results of LN assessment and/or comparisons of hysterectomy results with and without lymph node assessment. This analysis was registered at PROSPERO International prospective register of systematic reviews (CRD42023443598).
RESULTS: A total of 447 studies were initially identified through database searching. The current analysis includes 7 studies comprising 1791 atypical endometrial hyperplasia patients who underwent hysterectomy with lymph node assessment. The incidence of positive lymph nodes among those who had undergone any LN evaluation was found to be 1.1% (95% CI 0.3%-2%). The rate of positive LNs was 1.4% (95% CI 0.2%-1.9%) among those who had undergone specifically SLN. 319 (44.3%, 95% CI 34%-54.7%) patients of the patients initially diagnosed with EIN/AH (n = 699), were finally upgraded to EC diagnosis. Fifteen percent of the final EC diagnosed patients were treated with adjuvant treatment. No significant difference regarding complication rates was noticed.
CONCLUSIONS: Our review indicates that the rate of metastatic LNs is <2% in patients undergoing surgical nodal evaluation for EIN/AH. However, the rate of complication for SLN mapping is low and may have an impact on postoperative therapy decisions in those diagnosed with malignancy.