Preoperative Diagnosis of Lymph Node Metastasis in Biliary and Pancreatic Carcinomas: Evaluation of the Combination of Multi-detector CT and Serum CA19-9 Level

Nanashima, Atsushi; Sakamoto, Ichiro; Hayashi, Tomayoshi; Tobinaga, Syuuichi; Araki, Motoo; Kitajima, Masaki; Nonaka, Takashi; Takeshita, Hiroaki; Hidaka, Shigekazu; Sawai, Terumitsu; Yasutake, Toru; Nagayasu, Takeshi

doi:10.1007/s10620-010-1180-y

Cited by 28 publications

(18 citation statements)

References 24 publications

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“…The results of our study are consistent with recent and initial data demonstrating that clinical staging, by low sensitivity, underestimates histopathological lymph node involvement (pN+) [6,[20][21][22]. However, by adding the criterion "inhomogeneous signal intensity" and "number of visible lymph nodes" to the size criterion, we were able to increase the sensitivity to 60% in comparison to previous findings (14%, Roche et al; 37% Nanashima et al; and 46.2%, Cao et al) with specificity remaining sufficient.…”

Section: Discussionsupporting

confidence: 92%

Accuracy of various criteria for lymph node staging in ductal adenocarcinoma of the pancreatic head by computed tomography and magnetic resonance imaging

et al. 2020

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Background: Lymph node staging of ductal adenocarcinoma of the pancreatic head (PDAC) by cross-sectional imaging is limited. The aim of this study was to determine the diagnostic accuracy of expanded criteria in nodal staging in PDAC patients. Methods: Sixty-six patients with histologically confirmed PDAC that underwent primary surgery were included in this retrospective IRB-approved study. Cross-sectional imaging studies (CT and/or MRI) were evaluated by a radiologist blinded to histopathology. Number and size of lymph nodes were measured (short-axis diameter) and characterized in terms of expanded morphological criteria of border contour (spiculated, lobulated, and indistinct) and texture (homogeneous or inhomogeneous). Sensitivities and specificities were calculated with histopathology as a reference standard. Results: Forty-eight of 66 patients (80%) had histologically confirmed lymph node metastases (pN+). Sensitivity, specificity, and Youden's Index for the criterion "size" were 44.2%, 82.4%, and 0.27; for "inhomogeneous signal intensity" 25.6%, 94.1%, and 0.20; and for "border contour" 62.7%, 52.9%, and 0.16, respectively. There was a significant association between the number of visible lymph nodes on preoperative CT and lymph node involvement (pN+, p = 0.031). Conclusion: Lymph node staging in PDAC is mainly limited due to low sensitivity for detection of metastatic disease. Using expanded morphological criteria instead of size did not improve regional nodal staging due to sensitivity remaining low. Combining specific criteria yields improved sensitivity with specificity and PPV remaining high.

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Section: Discussionsupporting

confidence: 92%

Accuracy of various criteria for lymph node staging in ductal adenocarcinoma of the pancreatic head by computed tomography and magnetic resonance imaging

et al. 2020

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“…Nanashima et al . assessed the utility of combining CT findings and serum CA 19‐9 levels in the diagnosis of LN metastases and reported raised CA 19‐9 levels in the absence of typical CT findings of a metastatic 16b1 LN in nine of 20 patients with 16b1 LN metastases . In the present study, patients with 16b1 LN metastases had significantly higher tumour marker (CEA and CA 19‐9) levels, which suggests that elevated levels of tumour markers may help to predict 16b1 LN metastases in patients with potentially resectable disease on preoperative evaluation.…”

Section: Discussionsupporting

confidence: 50%

“…Future strategies should seek to improve preoperative detection and to avoid non‐therapeutic laparotomy secondary to 16b1 LN metastases. Endoscopic US (EUS) is a promising method of assessing the 16b1 LN and of performing image‐guided FNAC . However, there are no studies on the role of EUS‐guided FNAC in detecting 16b1 LN metastases in GBC and a prospective study is currently underway to ascertain whether the addition of EUS (with guided FNAC in patients with enlarged nodes) could obviate false negative results associated with percutaneous FNAC.…”

Section: Discussionmentioning

confidence: 99%

Role of routine 16b1 lymph node biopsy in the management of gallbladder cancer: an analysis

Agarwal

Kalayarasan²,

Javed³

et al. 2014

HPB

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“…In current clinical practice, the preoperative LN status in ICC is evaluated mainly based on the morphological features of the lymph nodes by reviewing the medical images preoperatively (for example, size and morphology of lymph nodes, signal changes within lymph nodes, etc. )5, 6. The prediction accuracy of current LN status evaluation method is often unstable and unsatisfactory.…”

Section: Introductionmentioning

confidence: 99%

A radiomics approach based on support vector machine using MR images for preoperative lymph node status evaluation in intrahepatic cholangiocarcinoma

Xu¹,

Yang²,

Liang³

et al. 2019

Theranostics

124

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Purpose : Accurate lymph node (LN) status evaluation for intrahepatic cholangiocarcinoma (ICC) patients is essential for surgical planning. This study aimed to develop and validate a prediction model for preoperative LN status evaluation in ICC patients. Methods and Materials : A group of 106 ICC patients, who were diagnosed between April 2011 and February 2016, was used for prediction model training. Image features were extracted from T1-weighted contrast-enhanced MR images. A support vector machine (SVM) model was built by using the most LN status-related features, which were selected using the maximum relevance minimum redundancy (mRMR) algorithm. The mRMR method ranked each feature according to its relevance to the LN status and redundancy with other features. An SVM score was calculated for each patient to reflect the LN metastasis (LNM) probability from the SVM model. Finally, a combination nomogram was constructed by incorporating the SVM score and clinical features. An independent group of 42 patients who were diagnosed from March 2016 to November 2017 was used to validate the prediction models. The model performances were evaluated on discrimination, calibration, and clinical utility. Results : The SVM model was constructed based on five selected image features. Significant differences were found between patients with LNM and non-LNM in SVM scores in both groups (the training group: 0.5466 (interquartile range (IQR), 0.4059-0.6985) vs. 0.3226 (IQR, 0.0527-0.4659), P <0.0001; the validation group: 0.5831 (IQR, 0.3641-0.8162) vs. 0.3101 (IQR, 0.1029-0.4661), P =0.0015). The combination nomogram based on the SVM score, the CA 19-9 level, and the MR-reported LNM factor showed better discrimination in separating patients with LNM and non-LNM, comparing to the SVM model alone (AUC: the training group: 0.842 vs. 0.788; the validation group: 0.870 vs. 0.787). Favorable clinical utility was observed using the decision curve analysis for the nomogram. Conclusion : The nomogram, incorporating the SVM score, CA 19-9 level and the MR-reported LNM factor, provided an individualized LN status evaluation and helped clinicians guide the surgical decisions.

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Preoperative Diagnosis of Lymph Node Metastasis in Biliary and Pancreatic Carcinomas: Evaluation of the Combination of Multi-detector CT and Serum CA19-9 Level

Abstract: Background. It is difficult to diagnose lymph node metastasis in biliary and pancreas

Cited by 28 publications

References 24 publications

Accuracy of various criteria for lymph node staging in ductal adenocarcinoma of the pancreatic head by computed tomography and magnetic resonance imaging

Accuracy of various criteria for lymph node staging in ductal adenocarcinoma of the pancreatic head by computed tomography and magnetic resonance imaging

Role of routine 16b1 lymph node biopsy in the management of gallbladder cancer: an analysis

A radiomics approach based on support vector machine using MR images for preoperative lymph node status evaluation in intrahepatic cholangiocarcinoma

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