The diagnostic accuracy of CT and MRI for the detection of lymph node metastases in gallbladder cancer: A systematic review and meta-analysis

Singh

et al. 2021

ASJO

Abstract Objective This work aimed to study the distribution of lymph nodal metastatic pattern in carcinoma gallbladder with multidetector computed tomography (CT). Materials and Methods A retrospective observational study was conducted including 80 patients with carcinoma gallbladder who underwent triple-phase CT angiography or single-phase contrast-enhanced CT scan of the abdomen between January 2019 and November 2019. Results In our study, 75 (93.7%) out of 80 cases showed metastasis to lymph nodes, with distribution as follows: periportal (69), peripancreatic (62), and aortocaval (47). The most common involved combination included all three lymph nodal groups (periportal, peripancreatic, and aortocaval), involving 40 (50%) cases. The combination of only periportal and peripancreatic lymph nodes was seen in 17 (21%) cases. Isolated periportal lymph nodes were seen in eight cases (10%) cases. The combination of only periportal and aortocaval lymph nodes was seen in four (5%) cases. Isolated peripancreatic lymph nodes were seen in three (3.7%) cases. The combination of periportal and aortocaval was seen in four (5%) cases followed by peripancreatic and aortocaval lymph nodes that was seen in two (2.5%) cases. Isolated aortocaval lymph nodes were seen in one (1.2%) case. Conclusion Periportal lymph nodes were the single most commonly involved station followed by peripancreatic and aortocaval lymph nodes. The combination of periportal, peripancreatic, and aortocaval lymph nodes was seen most commonly. The second most commonly involved combination was found to be periportal and peripancreatic lymph nodes followed by isolated periportal lymph nodes.

Section: Asian J Oncolsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Lymph Nodal Metastatic Pattern in Carcinoma Gallbladder with Multidetector Computed Tomography: An Institutional Experience

Singh

et al. 2021

ASJO

“…Moreover, the preoperative diagnosis of lymph node metastasis in patients with GBC was also reported with a sensitivity ranging from 0.25-0.93 for CT and 0.59-0.93 for MRI, and specificity of 1.00 for CT and 0.78-1.00 for MRI [25]. Small (<10 mm) lymph node metastases were frequently undetected in pre-operative imaging [25]. Endoscopic ultrasound-guided fine-needle aspiration for diagnosis of para-aortic lymph node metastasis has a reported sensitivity of 96.7% and a specificity of 100% [26].…”

Section: Discussionmentioning

confidence: 94%

“…The correct diagnostic rate for classification of malignant hilar obstruction, which corresponds to the "invasion of the left margin or entire areas of the hepatoduodenal ligament" in our study, has been reported to be 90.5% for CT and 81.0-85.7% for MRI, and may sometimes underestimate the degree of biliary stricture [24]. Moreover, the preoperative diagnosis of lymph node metastasis in patients with GBC was also reported with a sensitivity ranging from 0.25-0.93 for CT and 0.59-0.93 for MRI, and specificity of 1.00 for CT and 0.78-1.00 for MRI [25]. Small (<10 mm) lymph node metastases were frequently undetected in pre-operative imaging [25].…”

Section: Discussionmentioning

confidence: 99%

Examination of Prognostic Factors Affecting Long-Term Survival of Patients with Stage 3/4 Gallbladder Cancer without Distant Metastasis

Higuchi

Yazawa

Uemura

et al. 2020

Cancers

In advanced gallbladder cancer (GBC) radical resection, if multiple prognostic factors are present, the outcome may be poor; however, the details remain unclear. To investigate the poor prognostic factors affecting long-term surgical outcome, we examined 157 cases of resected stage 3/4 GBC without distant metastasis between 1985 and 2017. Poor prognostic factors for overall survival and treatment outcomes of a number of predictable preoperative poor prognostic factors were evaluated. The surgical mortality was 4.5%. In multivariate analysis, blood loss, poor histology, liver invasion, and ≥4 regional lymph node metastases (LNMs) were independent prognostic factors for poor surgical outcomes; invasion of the left margin or the entire area of the hepatoduodenal ligament and a Clavien–Dindo classification ≥3 were marginal factors. The analysis identified outcomes of patients with factors that could be predicted preoperatively, such as liver invasion ≥5 mm, invasion of the left margin or the entire area of the hepatoduodenal ligament, and ≥4 regional LNMs. Thus, the five-year overall survival was 54% for zero factors, 34% for one factor, and 4% for two factors (p < 0.05). A poor surgical outcome was likely when two or more factors were predicted preoperatively; therefore, new treatment strategies are required for such patients.

“…CECT images were retrospectively analyzed by two radiologists (one with 8 years of abdominal imaging experience and one with 10 years of abdominal imaging experience) who were blinded to the clinical and pathological data. Assessments included the following: (1) lesion location (head, body or tail); (2) LN status based on abdominal imaging evaluation criteria (location, size, shape, and LN enhancement) [26,27]. If the evaluation results were different, the final data were obtained after consultation between the two observers.…”

Section: Ct Protocols and Radiographic Evaluationsmentioning

confidence: 99%

Contrast-enhanced CT radiomics for predicting lymph node metastasis in pancreatic ductal adenocarcinoma: a pilot study

Yao

Xiao

et al. 2020

Cancer Imaging

Background:We developed a computational model integrating clinical data and imaging features extracted from contrast-enhanced computed tomography (CECT) images, to predict lymph node (LN) metastasis in patients with pancreatic ductal adenocarcinoma (PDAC).Methods: This retrospective study included 159 patients with PDAC (118 in the primary cohort and 41 in the validation cohort) who underwent preoperative contrast-enhanced computed tomography examination between 2012 and 2015. All patients underwent surgery and lymph node status was determined. A total of 2041 radiomics features were extracted from venous phase images in the primary cohort, and optimal features were extracted to construct a radiomics signature. A combined prediction model was built by incorporating the radiomics signature and clinical characteristics selected by using multivariable logistic regression. Clinical prediction models were generated and used to evaluate both cohorts. Results: Fifteen features were selected for constructing the radiomics signature based on the primary cohort. The combined prediction model for identifying preoperative lymph node metastasis reached a better discrimination power than the clinical prediction model, with an area under the curve of 0.944 vs. 0.666 in the primary cohort, and 0.912 vs. 0.713 in the validation cohort.Conclusions: This pilot study demonstrated that a noninvasive radiomics signature extracted from contrastenhanced computed tomography imaging can be conveniently used for preoperative prediction of lymph node metastasis in patients with PDAC.