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Patients with sentinel-node metastasis at the time of breast-cancer surgery may undergo axillary dissection to remove more nodes, which can lead to side effects. In a trial, the additional surgery did not prolong survival.

ObjectivesTo establish a diagnostic tree analysis (DTA) model based on ultrasonography (US) findings and clinical characteristics for differential diagnosis of common causes of cervical lymphadenopathy in children.MethodsA total of 242 patients (131 boys, 111 girls; mean age, 11.2 ± 0.3 years; range, 1 month–18 years) with pathologically confirmed Kikuchi disease (n = 127), reactive hyperplasia (n = 64), lymphoma (n = 24), or suppurative lymphadenitis (n = 27) who underwent neck US were included. US images were retrospectively reviewed to assess lymph node (LN) characteristics, and clinical information was collected from patient records. DTA models were created using a classification and regression tree algorithm on the basis of US imaging and clinical findings. The patients were randomly divided into training (70%, 170/242) and validation (30%, 72/242) datasets to assess the diagnostic performance of the DTA models.ResultsIn the DTA model based on all predictors, perinodal fat hyperechogenicity, LN echogenicity, and short diameter of the largest LN were significant predictors for differential diagnosis of cervical lymphadenopathy (overall accuracy, 85.3% and 83.3% in the training and validation datasets). In the model based on categorical parameters alone, perinodal fat hyperechogenicity, LN echogenicity, and loss of fatty hilum were significant predictors (overall accuracy, 84.7% and 86.1% in the training and validation datasets).ConclusionsPerinodal fat hyperechogenicity, heterogeneous echotexture, short diameter of the largest LN, and loss of fatty hilum were significant US findings in the DTA for differential diagnosis of cervical lymphadenopathy in children.Key Points• Diagnostic tree analysis model based on ultrasonography and clinical findings would be helpful in differential diagnosis of pediatric cervical lymphadenopathy.• Significant predictors were perinodal fat hyperechogenicity, heterogeneous echotexture, short diameter of the largest LN, and loss of fatty hilum.

The Sydney lymphadenopathy cytology system was proposed in 2020, but its validation for neck ultrasound-guided fine-needle aspiration cytology remains to be explored. Patients with lymphadenopathy who underwent ultrasound and cytology were included. The final diagnosis relies on histology and consensus of the multidisciplinary team. Cytology results follow the Sydney system (L1-L5); L3-L5 categories indicate malignancy, and we further calculate sensitivity, specificity, and overall accuracy. From July 2020 to April 2023, a total of 208 patients were included, of which 68 had malignant tumors and 140 were benign cases. According to the Sydney system, the malignancy rates for L2 to L5 are 2%, 89%, 100%, and 98%, respectively. The Sydney system demonstrated 97% sensitivity, 99% specificity, and 99% accuracy in the diagnosis of neck lymphadenopathy. The study shows that the Sydney system is highly effective in reporting neck lymphadenopathy.

PurposeTo investigate the application of deep learning combined with traditional radiomics methods for classifying enlarged cervical lymph nodes.MethodsThe clinical and computed tomography (CT) imaging data of 276 patients with enlarged cervical lymph nodes (150 with lymph-node metastasis, 65 with lymphoma, and 61 with benign lymphadenopathy) who were treated at the hospital from January 2015 to January 2021 were retrospectively analysed. The patients were randomly divided into a training group and a test group at a ratio of 8:2. The radiomics features were extracted using one-by-one convolution and neural network activation, filtered with the least absolute shrinkage and selection operator (LASSO) model, and used to construct a discrimination model with PyTorch. Then, the performance of the model was compared with the radiologists’ diagnostic performance. The neural network model was evaluated using the area under the receiver-operator characteristic curve (AUC), and the accuracy, sensitivity, and specificity were analysed.ResultsA total of 102 features, comprising five traditional radiomic features and 97 deep learning features, were selected with LASSO and used to construct a discrimination model, which achieved a total accuracy of 87.50%. The AUC value, specificity, and sensitivity were, respectively, 0.92, 92.30%, and 90.00% for metastatic lymph nodes, 0.87, 95.45%, and 83.33% for benign lymphadenopathy, and 0.88, 90.47%, and 85.71% for lymphoma. The accuracies of the radiologists’ diagnoses were 62.68% and 62.68%. The diagnostic performance of the model was significantly different from that of the radiologists (p < 0.05).ConclusionCT-based deep learning combined with the traditional radiomics methods has a high diagnostic value for the classification of cervical enlarged lymph nodes.

It has been nearly half a century since angioimmunoblastic T-cell lymphoma (AITL) was characterized in the early 1970’s. Our understanding of the disease has dramatically changed due to multiple discoveries and insights. One of the key features of AITL is aberrant immune activity. Although AITL is now understood to be a neoplastic disease, pathologists appreciated that it was an inflammatory condition. The more we understand AITL at cellular and genetic levels, the more we view it as both a neoplastic and an inflammatory disease. Here, we review recent progress in our understanding of AITL, focusing on as yet unsolved questions.

A previously healthy 8-year-old girl was transferred to a Boston hospital from Nantucket (an island off the coast of Massachusetts) with a 12-day history of fevers, sore throat, and cervical lymphadenopathy.

Background Internal mammary lymphadenopathy (IML) plays a role in breast cancer stage and prognosis. We aimed to evaluate method of IML detection, how IML impacts response to neoadjuvant chemotherapy (NAC), and oncologic outcomes. Methods We evaluated patients enrolled in the I-SPY-2 clinical trial from 2010 to 2022. We captured the radiographic method of IML detection (magnetic resonance imaging [MRI], positron emission tomography/computed tomography [PET/CT], or both) and compared patients with IML with those without. Rates of locoregional recurrence (LRR), distant recurrence (DR) and event-free survival (EFS) were compared by bivariate analysis. Results Of 2095 patients, 198 (9.5%) had IML reported on pretreatment imaging. The method of IML detection was 154 (77.8%) MRI only, 11 (5.6%) PET/CT only, and 33 (16.7%) both. Factors associated with IML were younger age ( p  = 0.001), larger tumors ( p  < 0.001), and higher tumor grade ( p  = 0.027). Pathologic complete response (pCR) was slightly higher in the IML group (41.4% vs. 34.0%; p  = 0.03). There was no difference in breast or axillary surgery ( p  = 0.41 and p  = 0.16), however IML patients were more likely to undergo radiation (68.2% vs. 54.1%; p  < 0.001). With a median follow up of 3.72 years (range 0.4–10.2), there was no difference between IM+ versus IM− in LRR (5.6% vs. 3.8%; p  = 0.25), DR (9.1% vs. 7.9%; p  = 0.58), or EFS (61.6% vs. 57.2%; p  = 0.48). This was true for patients with and without pCR. Conclusions In this large cohort of patients treated with NAC, outcomes were not negatively impacted by IML. We demonstrated that IML influences treatment selection but is not a poor prognostic indicator when treated with modern NAC and multidisciplinary disease management.

A 69-year-old female presented with hypercalcemia, recurrent fever, and lymphadenectasis following COVID-19 infection. Positron emission tomography/computed tomography (PET-CT) revealed no suspicious malignancy. Lymph node biopsy from bilateral inguinal areas suggested Langerhans cell histiocytosis, supporting a possible diagnosis of dermatopathic lymphadenitis or rare Langerhans cell histiocytosis. The immunohistology staining showed that the proliferated Langerhans cells in lymph nodes expressed CD68, CD1a, and S100, further supporting the diagnosis of dermatopathic lymphadenitis. The patient was diagnosed with dermatopathic lymphadenopathy. The patient underwent a therapy of prednisone acetate at 30 mg per day. Then, glucocorticoid was gradually decreased by 2.5 mg per 2 weeks, until it reached 7.5 mg per day. Salmon calcitonin was subcutaneously injected to decrease the calcium level and relieve pain during hospitalization. During the 3 months of treatment, the systemic symptoms were significantly alleviated. The lymph nodes of the right inguinal area and the serum calcium level decreased to normal. She remained in remission for an additional 4 years. Coexistence of the two unrelated diseases, dermatopathic lymphadenopathy and hypercalcemia, was rare. Immune dysregulation and persistent inflammatory responses post-COVID-19 infection may be the potential mechanism for hypercalcemia.

Rheumatoid arthritis-related interstitial lung disease (RA-ILD) is a common connective tissue disease-related ILD (CTD-ILD) associated with high morbidity and mortality. Although rheumatoid factor (RF) seropositivity is a risk factor for developing RA-ILD, the relationship between RF seropositivity, mediastinal lymph node (MLN) features, and disease progression is unknown. We aimed to determine if high-titer RF seropositivity predicted MLN features, lung function impairment, and mortality in RA-ILD. In this retrospective cohort study, we identified patients in the University of Chicago ILD registry with RA-ILD. We compared demographic characteristics, serologic data, MLN size, count and location, and pulmonary function over 36 months among patients who had high-titer RF seropositivity (≥ 60 IU/ml) and those who did not. Survival analysis was performed using Cox regression modeling. Amongst 294 patients with CTD-ILD, available chest computed tomography (CT) imaging and serologic data, we identified 70 patients with RA-ILD. Compared to RA-ILD patients with low-titer RF, RA-ILD patients with high-titer RF had lower baseline forced vital capacity (71% vs. 63%; P  = 0.045), elevated anti-cyclic citrullinated peptide titer (122 vs. 201; P  = 0.001), CT honeycombing (50% vs. 80%; P  = 0.008), and higher number of MLN ≥ 10 mm (36% vs. 76%; P  = 0.005). Lung function decline over 36 months did not differ between groups. Primary outcomes of death or lung transplant occurred more frequently in the high-titer RF group (HR 2.8; 95% CI 1.1–6.8; P  = 0.028). High-titer RF seropositivity was associated with MLN enlargement, CT honeycombing, and decreased transplant-free survival. RF titer may be a useful prognostic marker for stratifying patients by pulmonary disease activity and mortality risk.

Activated phosphoinositide 3-kinase delta syndrome (APDS) is a primary immunodeficiency caused by gain-of-function mutations in the PIK3CD gene, leading to dysregulated immune responses. Clinical manifestations include recurrent infections, lymphoproliferation, and increased risk of malignancies. Due to its rarity and variable presentation, APDS is often misdiagnosed or diagnosed late. We report a case of a 12-year-old girl presenting with persistent cervical lymphadenopathy. Imaging studies revealed extensive lymph node involvement and splenomegaly. PET-CT raised suspicion for lymphoma. Histopathology of the excised lymph node demonstrated Epstein-Barr virus (EBV) latent infection Type III, while whole exome sequencing identified a pathogenic PIK3CD c.3061G>A (p.Glu1021Lys) heterozygous variant. This confirmed the diagnosis of APDS. Targeted therapy with sirolimus was initiated, leading to significant regression of lymphadenopathy and splenomegaly. The patient maintained good clinical status during follow-up. This case highlights the importance of genetic testing in pediatric patients with lymphoproliferative disease and unusual infection patterns. Early diagnosis of APDS enables personalized, targeted treatment and avoids overtreatment with cytotoxic agents.