Leucine-rich alpha-2 glycoprotein as a marker of mucosal healing in inflammatory bowel disease.

Leucine-rich alpha-2 glycoprotein (LRG) may be a novel serum biomarker for patients with inflammatory bowel disease. The association of LRG with the endoscopic activity and predictability of mucosal healing (MH) was determined and compared with those of C-reactive protein (CRP) and fecal markers (fecal immunochemical test [FIT] and fecal calprotectin [Fcal]) in 166 ulcerative colitis (UC) and 56 Crohn's disease (CD) patients. In UC, LRG was correlated with the endoscopic activity and could predict MH, but the performance was not superior to that of fecal markers (areas under the curve [AUCs] for predicting MH: LRG: 0.61, CRP: 0.59, FIT: 0.75, and Fcal: 0.72). In CD, the performance of LRG was equivalent to that of CRP and Fcal (AUCs for predicting MH: LRG: 0.82, CRP: 0.82, FIT: 0.70, and Fcal: 0.88). LRG was able to discriminate patients with MH from those with endoscopic activity among UC and CD patients with normal CRP levels. LRG was associated with endoscopic activity and could predict MH in both UC and CD patients. It may be particularly useful in CD.

Diagnosis of cervical lymph node metastases in head and neck cancer with ultrasonic measurement of lymph node volume.

OBJECTIVE: The purpose of this study was to evaluate the usefulness of ultrasound (US) volume measurement of the cervical lymph nodes for diagnosing nodal metastasis in patients with head and neck cancer using a node-by-node comparison. METHODS: Thirty-four consecutive patients with head and neck cancer from one tertiary university hospital were prospectively enrolled from 2012 to 2017. Patients with histologically proven squamous cell primary tumors in the head and neck region scheduled to undergo a therapeutic neck dissection were eligible. For each patient, 1-4 target lymph nodes were selected from the planned neck dissection levels. Lymph nodes with thickness >20 mm or in a cluster were excluded. Node-by-node comparisons between the pre-operative US assessment, the post-operative actual measurements and histopathological results were performed for all target lymph nodes. Quantitative measurements, such as three diameters, ratios of the three diameters and volume were analyzed in this study. Lymph node volume was calculated using the ellipsoid formula. RESULTS: Patients comprised 28 men and 6 women with a mean age of 60.0 years (range, 29-80 years) at the time of surgery. In total, 67 target lymph nodes were analyzed in this study and the thickness ranged from 3.9 to 20.0 mm (mean 8.0 mm). There was a strong correlation between the US volume and post-operative actual volume (ρ = 0.87, p < 0.01). The US volume measured 2156 ± 2156 mm3 for the tumor positive nodes, which was significantly greater than the US volume of 512 ± 315 mm3 for tumor negative nodes (p < 0.01). Significant differences between tumor positive and tumor negative nodes were found in five variables (volume, thickness, major axis, minor axis and ratio of minor axis to thickness) for total lymph nodes. To identify predictors of lymph node metastasis, ROC curves of the US variables of target lymph nodes were compared, of which 4 variables were considered acceptable for predicting the lymph node metastasis: volume (AUC 0.86), thickness (AUC 0.86), major axis (AUC 0.79), and minor axis (AUC 0.79) for total lymph nodes. The optimal cut-off level for US volume in total lymph nodes was found to be 1242 mm3, whereby a 62% sensitivity and 98% specificity was reached (likelihood ratio: 25.2). CONCLUSION: Pre-operative ultrasonic volume measurement of the cervical lymph nodes was useful for early detection of cervical nodal metastasis in head and neck cancer.

Diagnosis of lymph node metastases of head and neck cancer and evaluation of effects of chemoradiotherapy using ultrasonography.

BACKGROUND: Ultrasonographic diagnostic criteria were established to detect cervical metastatic lymph nodes including those up to 10 mm in thickness. Ultrasonography can diagnose not only cervical metastatic lymph nodes but can also be used to evaluate treatment-induced changes in lymph node metastases, one by one or degeneration of metastatic lesion in remaining lymph nodes after chemoradiotherapy. METHODS: A high-frequency probe of 7.5 MHz or higher was used in the ultrasonographic diagnosis of cervical lymph node metastases, using B-mode, Doppler blood flow imaging, and tissue elasticity imaging. Cervical lymph node metastases of head and neck squamous cell carcinoma were diagnosed according to ultrasonographic lymph node metastasis criteria. These criteria consist of the thickness of a lymph node (more than 6 mm or not), and existence of intra-lymph nodal occupying lesions suspected as a metastatic focus or not. Furthermore, metastatic lymph nodes remaining without regression after chemoradiotherapy were also evaluated according to therapeutic effect, using ultrasonography, and we examined the efficacy of ultrasonography to predict clinical outcomes. RESULTS: These diagnostic criteria enabled the accurate diagnosis of metastatic lymph nodes that were up to 10-mm-thick; such nodes are difficult to diagnose by computed tomography (CT) or magnetic resonance imaging (MRI). Moreover, examination of therapeutic effects such as decreased blood flow into a metastatic focus, and softening of a lymph node, by evaluating B-mode dynamic images or employing tissue elasticity imaging, was also useful to determine the effectiveness of chemoradiotherapy and a favorable outcome. CONCLUSION: Ultrasonographic diagnostic criteria for cervical metastatic lymph nodes enabled accurate diagnosis. Ultrasonographic evaluation of therapeutic effects on cervical lymph node metastases revealed not only the control of metastasis in the cervical region but also the clinical course and control of the primary site.

[Clinical application of real-time tissue elastography to head and neck cancer--evaluation of cervical lymph node metastasis with real-time tissue elastography].

Real-time tissue elastography (elastography) is a new ultrasonography procedure that display tissue elasticity. We evaluated the usefulness of elastography in the diagnosis of cervical lymph node metastasis and its treatment results in patients with head and neck cancer. Metastatic lymph nodes tended to produce little distortion when displayed as hard tumors, and produced distortion, displayed as soft tumors, after radiation therapy and/or chemotherapy. Elastography thus is useful as a potential new diagnostic procedure in the diagnosis of neck lymph node metastasis in head and neck cancer.