Number and size of lymph nodes and node metastases in rectal carcinomas

Dworák, O.

doi:10.1007/bf00590909

Cited by 130 publications

(63 citation statements)

References 6 publications

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“…First, the length of the specimen is variable in rectal cancer compared to colon cancer, which leads to fewer number of total lymph nodes retrieved in rectal cancer (20). Second, lymph nodes in mesocolon are larger in size than those in mesorectum, which may be difficult to identify (22). And third, neoadjuvant treatment has an established role in locally advanced rectal cancer, but not in colon cancers, and thus, has become the standard treatment in rectal cancer (23,24).…”

Section: Discussionmentioning

confidence: 99%

Less than 12 lymph nodes in the surgical specimen after neoadjuvant chemo-radiotherapy: an indicator of tumor regression in locally advanced rectal cancer?

Gurawalia¹,

Dev²,

Nayak³

et al. 2016

J. Gastrointest. Oncol.

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Background: The number of lymph node retrieved in the surgical specimen is important for tumor staging and has paramount impact on prognosis in colorectal cancer and imitates the adequacy of lymph node surgical clearance. The paucity of lymph node yields in patients undergoing resection after preoperative chemo radiotherapy (CRT) in rectal cancer has seen. Lower total number of lymph nodes in the total mesoractal excision (TME) specimen after CRT, could a marker of better tumor response. Methods: We retrospectively reviewed the prospectively managed data of patients underwent excision for rectal cancer, who treated by neoadjuvant radiotherapy with or without chemotherapy in locally advanced rectal cancer. From 2010 to 2014, 364 patients underwent rectal cancer surgery, of which ninety-one treated with neoadjuvant treatment. Standard surgical and pathological protocols were followed. Patients were categorized into two groups based on the number of total harvested lymph nodes with group 1, having 12 or more nodes harvested, and group 2 including patients who had <12 lymph nodes harvested. The total number of lymph nodes retrieved from the surgical specimen was correlated with grade of tumor regression with neoadjuvant treatment. Results: Out of 91 patients, 38 patients (42%) had less than 12 lymph nodes examined in specimen. The difference in median number of lymph nodes was observed significantly as 9 (range, 2-11) versus 16 (range, 12-32), in group 2 and 1, respectively (P<0.01). Patients with fewer lymph node group were comparable with respect to age, BMI, pre-operative staging, neoadjuvant treatment. Pathological complete response in tumor pCR was seen with significantly higher rate (40% vs. 26%, P<0.05) in group 2. As per Mandard criteria, there was significant difference in tumor regression grade (TRG) between both the groups (P<0.05). Among patients with metastatic lymph nodes, median LNR was lower in <12 lymph nodes group at 0.167 (range, 0.09-0.45) versus 0.187 (range, 0.05-0.54), difference was not statistically significant (P=0.81).Conclusions: Retrieval of fewer than 12 lymph nodes in surgical specimen of rectal cancer who had received neo-adjuvant radiotherapy with or without chemotherapy should be considered as a good indicator of tumor response with better local disease control, and a good prognostic factor, rather than as a pointer of poor diligence of the surgical and pathological assessment.

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Section: Discussionmentioning

confidence: 99%

Less than 12 lymph nodes in the surgical specimen after neoadjuvant chemo-radiotherapy: an indicator of tumor regression in locally advanced rectal cancer?

Gurawalia¹,

Dev²,

Nayak³

et al. 2016

J. Gastrointest. Oncol.

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“…Because we used thinner slices (5 mm), in many cases, we found tiny nodules in the adjacent fat that were responsible for the high rate of false-positive results when the criteria for reading B for metastatic lymph node involvement were applied. Thus, the use of a 5-mm lymph node diameter as a cutoff value seems to be a reasonable compromise when considering that the majority of metastatic nodes of rectal carcinoma are in fact very small [17].…”

Section: Discussionmentioning

confidence: 99%

Water enema computed tomography (WE-CT) in the local staging of low colorectal neoplasms: comparison with transrectal ultrasound

et al. 1998

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Background: To determine the accuracy of computed tomography performed with a water enema application (WE-CT) in the local staging of low colorectal neoplasms and to compare the results with those of transrectal ultrasonography (TRUS). Methods: Forty patients with low colorectal tumors were evaluated prospectively by CT with the simultaneous administration of a lukewarm rectal enema (0.5-1.5 L). Thin slices (5 mm) and intravenous application of iodinated contrast media were routinely used. TRUS was performed in 18 patients. Tumor size, location, and staging according to the TNM classification of the UICC were registered. Tumors were classified as õT3 (T1 or T2) or as T3 or T4. For staging peritumoral lymph node metastases on WE-CT, two criteria of positivity were tested: N/ if at least one peritumoral node ¢5 mm in diameter was seen (reading A); N/ if at least one peritumoral node ¢5 mm or three peritumoral nodes õ5 mm were identified (reading B). Results: For the tumor staging, WE-CT showed a sensitivity of 90%, a specificity of 73%, a positive predictive value (PPV) of 90%, a negative predictive value (NPV) of 73%, and an accuracy of 85%. For TRUS, the results were sensitivity of 73%, specificity of 29%, PPV of 62%, NPV of 40%, and an accuracy of 39%. Concerning nodal staging with WE-CT, results were superior when reading A was used: sensitivity Å 84%, specificity Å 83%, PPV Å 73%, NPV Å 91%, and accuracy Å 84%. TRUS showed a sensitivity of 29%, specificity of 100%, PPV of 100%, NPV of 67%, and an accuracy of 71%.Correspondence to: F. Caseiro-Alves Conclusion: WE-CT is a reliable technique for the local staging of low colorectal tumors that can be superior to TRUS. For diagnosis of peritumoral metastatic lymph nodes on WE-CT, the 5-mm diameter cutoff value is the most appropriate size criterion.

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“…Planar imaging modalities such as CT only rely on size and shape criteria. As has already been described by Dworak in 1989 [17], a substantial percentage of patients with positive nodal status (32%) only has nodes smaller than 5 mm, and there are even cases in which positive nodes are smaller than 2 mm (8%). Therefore, when relying on size and shape only, sensitivity for detection of nodal involvement is low (MRI: 66%, CT: 55%) [18].…”

Section: Locoregional Stagingmentioning

confidence: 73%

Role of Preoperative Local and Distant Staging in Rectal Cancer

Engelen

Beets

2007

Oncol Res Treat

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Preoperative imaging in rectal cancer is very important, as accurate staging determines optimal treatment strategy. In this review, imaging modalities for locoregional and distant staging in rectal cancer are discussed. For local staging, superficial tumors are best staged using endorectal US (EUS), as EUS is the most accurate modality for assessment of tumor ingrowth into the rectal wall layers. The more advanced tumors are best imaged using MRI, because MRI accurately predicts the distance from tumor to mesorectal fascia, and thus the circumferential resection margin (CRM), as well as possible invasion into surrounding organs. For the prediction of the nodal status none of the three imaging modalities - EUS, MRI and CT - can be reliably used for clinical decisionmaking. Only MRI using lymph node specific contrast (such as ultrasmall paramagnetic iron oxide-enhanced MRI) seems promising for the detection of nodal disease. For the detection of distant metastases transabdominal ultrasound and chest X-ray are used as a primary screening tool. However, for the high prevalence group (stage III) both methods are insufficiently sensitive, and CT of the chest plus abdomen is preferred.

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Number and size of lymph nodes and node metastases in rectal carcinomas

Cited by 130 publications

References 6 publications

Less than 12 lymph nodes in the surgical specimen after neoadjuvant chemo-radiotherapy: an indicator of tumor regression in locally advanced rectal cancer?

Less than 12 lymph nodes in the surgical specimen after neoadjuvant chemo-radiotherapy: an indicator of tumor regression in locally advanced rectal cancer?

Water enema computed tomography (WE-CT) in the local staging of low colorectal neoplasms: comparison with transrectal ultrasound

Role of Preoperative Local and Distant Staging in Rectal Cancer

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