Anatomical Characterization of the Inguinal Lymph Nodes Using Micro‐Computed Tomography to Inform Radical Inguinal Lymph Node Dissections for Metastatic Penile Cancer
Notice bibliographique
Résumé
Background, Rationale & Aim In men with penile cancer, a radical inguinal lymph node dissection (rILND) is integral to prevent metastasis and improve disease specific survival. Unfortunately, lymphocele and lymphedema are severe post‐surgical complications that are common to this procedure. The development of a modified inguinal lymph node dissection, that greatly reduced the amount of lymphatic resection, was effective at reducing the incidence of lymphedema and lymphocele; however, it was not suited for patients with advanced‐stage disease as it risked an incomplete cancer resection. As such, there exists a clinical need for a novel surgical template ‐ informed by the lymphatic anatomy ‐ to reduce these post‐surgical complications while ensuring a thorough cancer resection. However, the lymphatic anatomy of the inguinal region is not well characterized in the literature, with no definitive location or number of lymph nodes reported. Therefore, this study aims to elucidate the lymphatic anatomy within the current surgical borders of a rILND using human cadavers. Methodology To visualize the position of the lymph nodes, tissue packets excised from the inguinal region were imaged using micro‐computed tomography (μCT; 154 μm Locus Ultra CT scanner). To characterize the distribution of lymph nodes within each tissue packet, lymph nodes were segmented by grayscale values in 3D using a modified seed‐growing algorithm (Region Growing v1.5; Kellner, 2011) in MATLAB. To compare anatomy between tissue packets, the segmented lymph nodes were aligned (registered) with one another by translating, scaling, rotating, and mirroring (if necessary) such that they were all superimposed in a common coordinate system. This was achieved using a specimen‐specific transformation matrix that was obtained from a generalized Procrustes analysis performed using the positions of four landmarks from each specimen; the anterior superior iliac spine, pubic tubercle, sapheno‐femoral junction, and sartorius as it crosses the femoral artery. These landmarks were chosen due to their consistency between individuals as well as their use as surgical landmarks. Results Preliminary findings from five samples (n=3 cadavers) show a median of 6 lymph nodes (range = 3–7); their anatomical distribution is illustrated in Figure . In addition to obtaining more specimens, ongoing work focuses on segmentation of structures in this region, such as saphenous vein and the sartorius muscle, to provide spatial context to the identified lymph node distribution. Significance & Implications This study provides the first standardized comparison of lymph node anatomy in the inguinal region, and utilizes a novel imaging methodology validated by our lab to study the anatomy of lymphatic tissue in 3D and in situ . In doing so, the anatomy elucidated in this study will help inform refinement to the borders of the radical surgical template, to limit unnecessary resection in an attempt to reduce the incidence of post‐surgical lymphedema and/or lymphocele. The standardized lymph node data after having the generalized Procrustes analysis applied. The dotted lines represent the rILND surgical borders. Figure 1
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».