PURPOSE: Papillary thyroid carcinoma (PTC) arising from the pyramidal lobe is rare; therefore, clinicopathologic evaluation is lacking. In addition, the rate of occult malignancy in the pyramidal lobe after thyroid surgery is unclear. This study is to evaluate the clinical characteristics of PTCs that involve the pyramidal lobe. METHODS: The study enrolled 1,107 patients who underwent thyroid surgery for PTC at Seoul National University Hospital from 2006 to 2015. Pyramidal lobe status in pathologic reports was clear in all cases. “Pyramidal lobe-dominant PTC” was defined as single pyramidal lobe cancer or multifocal cancer with larger pyramidal lobe tumor. “Incidental pyramidal lobe PTC” was defined as occult cancer identified after thyroidectomy or as multifocal cancer with smaller pyramidal lobe tumor. RESULTS: Ten patients were included in the pyramidal lobe-dominant PTC group. The mean age was 58 ± 12.5 years, and the mean tumor size was 0.7 ± 0.7 cm. Cervical lymph node metastasis was found in 5 patients (50%). Three patients had microscopic lymphatic invasion, and 7 had advanced American Joint Comitee on Cancer (AJCC) stage disease (5 with stage III and 2 with stage IV). Compared with conventional PTC (n = 1,058), pyramidal lobe-dominant PTC was significantly associated with lymphatic invasion (P = 0.031) and advanced AJCC stage (P = 0.022). The prevalence of incidental pyramidal lobe PTC was 3.56%. CONCLUSION: Pyramidal lobe PTC is relatively small in size; however, the rate of extrathyroidal extension and lymph node metastasis is high. Preoperative evaluation of nodal status is important, and the extent of surgery should be determined in accordance with the preoperative diagnosis.
Diagnosis ; Humans ; Joints ; Lymph Nodes ; Lymphatic Metastasis ; Neoplasm Metastasis ; Prevalence ; Seoul ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

Acquaintance of the lymph node is very important to evaluate whether the tumor is malignant or benign and therefore to the treatment of the tumors. Lymphography is now considered the gold standard for this purpose. Many computer aided diagnose (CAD) technologies have been developed to help radiologists to diagnose the tumor by the lymphography cases. In this paper, a computer aided diagnose model is constructed by Semi-naive Bayes Classification. The experiments carried out in our laboratory validated the Semi-Naive Bayes Classification on lymphography case. The result of experiments showed that Semi-Naive Bayes Classification could classify lymphography case effectively.
Algorithms ; Bayes Theorem ; Diagnosis, Computer-Assisted ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; diagnosis ; Lymphography ; Neoplasms ; diagnosis

Axillary disorders originate from an axillary lymph node, subcutaneous fat layer, accessory breast, nerve, vessel and muscle. The most common causes of a palpable axillary mass are a lymph node pathology containing a benign axillary lymphadenopathy, and malignant lymph nodes such as a metastatic lymphadenopathy from breast cancer and a malignant lymphoma. For the detection of masses in the axilla, mammography and sonography are the imaging modalities of choice. We present a spectrum of various axillary masses with correlative radiological imaging and pathological findings in this pictorial essay. Knowledge of the radiological findings of various axillary disorders is useful for a differential diagnosis and for preventing unnecessary invasive procedures.
Animals ; Axilla ; Breast Neoplasms ; Breast* ; Diagnosis, Differential ; Lymph Nodes ; Lymphatic Diseases ; Lymphatic Metastasis ; Lymphatic System ; Lymphoma ; Mammary Neoplasms, Animal ; Mammography ; Neoplasm Metastasis* ; Pathology ; Radiography ; Subcutaneous Fat ; Ultrasonography

OBJECTIVETo analyze the clinical application value of the 7th edition UICC-AJCC TNM pT classification of gastric cancer.

METHODSThe classification of tumor invasion depth of 874 cases of gastric cancer was determined using the 7th edition UICC-AJCC TNM classification and the relationships of prognosis with clinicopathological factors was compared with that obtained using the 6th edition TNM classification.

RESULTSThe 5-year survival rates according to the 6th edition pT1, pT2, pT3, pT4 were 98.4%, 55.8%, 26.0% and 24.5%, respectively, showing a significant difference among the four substages (P<0.001). The 5-year survival rates according to the 7th edition pT1a, pT1b, pT2, pT3, pT4a, and pT4b were 98.6%, 98.2%, 75.8%, 48.9%, 26.0% and 24.5%, respectively, and there were significant differences in survival time among the six substages (P<0.001). According to the 7th edition TNM classification, for the pT2 and pT3 patients groups, the 5-year survival rates of the 7th edition pN0 (without lymphatic metastasis) were 84.8% and 77.9%, respectively, showing no significant difference between the two survival rates (P=0.204). The 5-year survival rates according to the 7th edition pNx (with lymphatic metastasis) were 66.9% and 37.5%, respectively, and there was a significant difference between the two survival times (P<0.001). In multivariate analysis, the 7th edition pT stage, vascular or lymphatic invasion, the 6th edition pT staging and primary tumor site were independent prognostic factors in patients with gastric cancer (P<0.05), and the relationship of the staging of the 7th version of pT was more close with the prognosis of patients with gastric carcinoma than that of the 6th edition of pT staging system.

CONCLUSIONThe 7th edition UICC-AJCC classification of pT staging of gastric cancer patients has a better prognostic predictive value than the 6th edition.

Authors compared early phase scan of the IV bolus CT (two phase incremental bolus dynamic CT) with late enhanecd scan similar to the conventional contrast enhanced CT for evaluation of the advantages of the IV bolus CT with two viewpoints of the pancreatic or peripancreatic mass and peripancreatic lymphadenopathy in 68 patients-28 cases of the pancreatic cancer, 6 cases of the pancreatitis and 34 cases of the pancreatic or peripancreatic metastasis. On the diagnosis of the pancreatic or peripancreatic mass, IV bolus CT could show the lesion(s) more easily in 41% (Grade II; 13/31) and much more easily in 34% (Grade III; 10/31) when compared with conventional contrast CT scan. The diagnosis of the peripancreatic lymph node involvement was also easy in 51%(Grade II; 20/39) and much easier in 37% (Grade III; 14/39). We thought that these differences were originated from the increase of the contrast between the lesion and normal portion because the early enhanced scans reflected the active blood flow change more exactly. Therefore IV bolus CT had advantages in comparison with the conventional drip infusion contrast CT in the diagnosis of the presence and pathologic extension of the pancreatic and peripancreatic lesion.
Diagnosis ; Infusions, Intravenous ; Lymph Nodes ; Lymphatic Diseases ; Neoplasm Metastasis ; Pancreatic Neoplasms ; Pancreatitis ; Tomography, X-Ray Computed

Authors compared early phase scan of the IV bolus CT (two phase incremental bolus dynamic CT) with late enhanecd scan similar to the conventional contrast enhanced CT for evaluation of the advantages of the IV bolus CT with two viewpoints of the pancreatic or peripancreatic mass and peripancreatic lymphadenopathy in 68 patients-28 cases of the pancreatic cancer, 6 cases of the pancreatitis and 34 cases of the pancreatic or peripancreatic metastasis. On the diagnosis of the pancreatic or peripancreatic mass, IV bolus CT could show the lesion(s) more easily in 41% (Grade II; 13/31) and much more easily in 34% (Grade III; 10/31) when compared with conventional contrast CT scan. The diagnosis of the peripancreatic lymph node involvement was also easy in 51%(Grade II; 20/39) and much easier in 37% (Grade III; 14/39). We thought that these differences were originated from the increase of the contrast between the lesion and normal portion because the early enhanced scans reflected the active blood flow change more exactly. Therefore IV bolus CT had advantages in comparison with the conventional drip infusion contrast CT in the diagnosis of the presence and pathologic extension of the pancreatic and peripancreatic lesion.
Diagnosis ; Infusions, Intravenous ; Lymph Nodes ; Lymphatic Diseases ; Neoplasm Metastasis ; Pancreatic Neoplasms ; Pancreatitis ; Tomography, X-Ray Computed

Liver metastasis from gastric cancer is a major cause of cancer-related death. Since liver metastasis from gastric cancer is usually associated with other non-curative factors, such as peritoneal metastasis, lymph node metastasis and extensive intrahepatic metastasis, the hepatic resection rate was low and the prognosis was poor. The main risk factors of liver metastasis were serosal invasion, p(+), N3-N4, differentiated histologic type, medullary type of poorly differentiated adenocarcinoma, vascular invasion, and overexpression and mutation of VEGF, P53 and c-erbb-2. The 5-year survival rate after hepatic resection of synchronous and metachronous liver metastasis from gastric cancer ranged from 11% to 42%. Appropriate patient selection for hepatic resection may confer a better prognosis of liver metastasis from gastric cancer.
Adenocarcinoma ; Humans ; Liver Neoplasms ; diagnosis ; secondary ; Lymphatic Metastasis ; Prognosis ; Risk Factors ; Stomach Neoplasms ; pathology ; Survival Rate

Adult ; Carotid Body Tumor ; diagnosis ; pathology ; surgery ; Humans ; Lymphatic Metastasis ; Male ; Recurrence

BACKGROUNDDiffusion-weighted imaging has been widely used to differentiate the character of lymphadenopathy. But there are significant differences between prior studies. The aim of the study was to compare the benefit of apparent diffusion coefficient (ADC) and rADC in the differentiation of metastatic and benign lymph nodes in a rabbit model.

METHODSTwo observers independently measured ADCs in quadriceps of every rabbit on diffusion-weighted images with different sizes of regions of interest (ROI). The appropriate ROI for rADC was determined using the interobserver coefficient. rADC was calculated by ADC(lesion)/ADC(reference site). Receiver operating characteristics (ROC) analysis was performed to compare the diagnostic value of the ADC values and rADC values in differentiating metastatic from benign lymph nodes.

RESULTSWhen the ROIs included five pixels, the ICC was 0.816, indicating a good interobserver agreement. The differences of ADC and rADC values between metastatic and benign lymph nodes were both statistically significant. The area under the ROC curve was greater for the rADC than for the ADC. With the rADC criteria of 0.640, the sensitivity and specificity for differentiating metastatic from benign lymph nodes were 93% and 90%, respectively.

CONCLUSIONAs a reference site, muscles reveal a good repeatability using a small ROI and the rADC may improve diagnostic accuracy for detecting metastatic nodes in animal models.

PURPOSE: Intraoperative assessment of lymph node status is important when performing limited surgery in gastric cancer patients. Currently available techniques are frozen section, imprint cytology, and other molecular methods, and most current studies use the frozen section method. In the present study, the authors focused on the accuracy and the feasibility of imprint cytology as a tool to assess the lymph node status intraoperatively in gastric cancer surgery. MATERIALS AND METHODS: Between April 2001 and March 2003, we performed imprint cytology of the sentinel nodes of 260 consecutive patients. After review by an experienced cytopathologist, the sensitivity, the specificity and the overall accuracy were determined. RESULTS: The time required for intraoperative imprint cytology was 8 minutes, and the sensitivity, the specificity and the overall accuracy were 52.2%, 88.8%, and 73.8%, respectively. CONCLUSION: Imprint cytology can be a useful technique for assessing lymph node status intraoperatively if the sensitivity and the specificity can be improved to an acceptable level.
Cytodiagnosis ; Diagnosis* ; Frozen Sections ; Humans ; Lymph Nodes* ; Lymphatic Metastasis ; Neoplasm Metastasis* ; Sensitivity and Specificity ; Sentinel Lymph Node Biopsy ; Stomach Neoplasms*