Usefulness of Two-Dimensional Values Measured Using Preoperative Multidetector Computed Tomography in Predicting Lymph Node Metastasis of Gastric Cancer

Lee, Su Lim; Lee, Han Hong; Ku, Young Mi; Jeon, Hae Myung

doi:10.1245/s10434-015-4621-1

Cited by 12 publications

(7 citation statements)

References 21 publications

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“…Pre-operative staging is mainly dependent on the size criteria as measured by MDCT [ 9 10 13 ]. Several previous studies have attempted to elucidate the optimal size criteria for deciding whether specific LNs are metastatic.…”

Section: Discussionmentioning

confidence: 99%

“…[ 11 ] A larger size cutoff value increases the positive predictive value and specificity, but inevitably leads to decreased sensitivity and negative predictive value. Two-dimensional values have also been evaluated for estimating LNM, but have failed to present definite size criteria for estimating LNM [ 10 ]. For this reason, a previous study for pre-operatively predicting LNM used tumor characteristics rather than pre-operative MDCT findings for LN size evaluation [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…There are several pre-operative modalities to estimate patient LN status. Among them, multi-detector computed tomography (MDCT) is most widely used for evaluating clinical N-stage with LN size and shape [ 9 10 ]. To increase the accuracy for estimating the presence of LN metastasis, various studies have suggested different size criteria [ 11 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Is Lymph Node Size a Reliable Factor for Estimating Lymph Node Metastasis in Early Gastric Cancer?

Kim

2018

J Gastric Cancer

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PurposePre-operative lymph node (LN) size is a valuable parameter for determining treatment strategy for gastric cancer. However, a correlation between LN size and metastasis has not been established.Materials and MethodsThirty-six LN-positive (LNP) and matched 36 LN-negative (LNN) patients were included, and pathology slides of the LNs of these patients were reviewed. All the LNs were measured along the long-axis (LA) and short-axis (SA), manually.ResultsAverage retrieved LNs were 37.3±19.8 and 40.5±11.6 in the LNN and LNP groups, respectively. In total 2,800 LNs, including 136 metastatic LNs (MLNs) and 2,664 non-metastatic LNs (nMLNs), were evaluated. Mean length was significantly more in MLNs along both, the LA and SA (MLN_LA vs. nMLN_LA: 4.97±3.84 vs. 3.37±2.40 mm, MLN_SA vs. nMLN_SA: 3.86±3.19 vs. 2.43±1.59 mm; P<0.001). However, 92.6% (126/136) and 95.6% (130/136) of MLNs were <10 mm along the LA and SA, respectively. In addition, only 22.2% of the LNP group exhibited an MLN as the largest LN.ConclusionsPre-operative multi-detector computed tomography has limited ability in estimating the presence of metastasis in LNs because most MLNs are less than 10 mm, and only a small proportion of the LNP group exhibits an MLN as the largest MLN.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is Lymph Node Size a Reliable Factor for Estimating Lymph Node Metastasis in Early Gastric Cancer?

Kim

2018

J Gastric Cancer

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“…With the continuous development of technology, MDCT has become the most commonly used technique for preoperative staging of GC. It provides specific value in the evaluation of infiltration depth, ascites, and distant metastasis but has limitations in the diagnosis of LNM ( 28 , 29 ). Although improved CT analysis techniques, including those that take into account size and/or imaging patterns (enhancement, necrosis, shape, and fat content), were used to assess LNM, the overall accuracy was also approximately 60–80% ( 30 , 31 ).…”

Section: Discussionmentioning

confidence: 99%

Establishment of Decision Rules and Risk Assessment Model for Preoperative Prediction of Lymph Node Metastasis in Gastric Cancer

Huang

Zhu

et al. 2020

Front. Oncol.

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Background: Preoperative accurate prediction of lymph node status is especially important for the formulation of treatment plans for patients with gastric cancer (GC). The purpose of this study was to establish decision rules and a risk assessment model for lymph node metastasis (LNM) in GC using preoperative indicators. Methods: The clinical data of 554 patients who underwent gastrectomy with D2 lymphadenectomy were collected. A 1:1 propensity score matching (PSM) system was used, and the clinical data of the matched 466 patients were further analyzed. The important risk factors for LNM were extracted by the random forest algorithm, and decision rules and nomogram models for LNM were constructed with a classification tree and the “rms” package of R software, respectively. Results: Tumor size ( OR : 2.058; P = 0.000), computed tomography (CT) findings ( OR : 1.969; P = 0.001), grade ( OR : 0.479; P = 0.000), hemoglobin (Hb) ( OR : 1.211; P = 0.005), CEA ( OR : 1.111; P = 0.017), and CA19-9 ( OR : 1.040; P = 0.033) were independent risk factors for LNM in GC. Tumor size did rank first in the ranking of important factors for LNM in GC and was the first-level segmentation of the two initial branches of the classification tree. The accuracy, sensitivity, specificity, and positive predictive value of the decision rules in diagnosing preoperative LNM in GC were 75.6, 85.7, 73.9, 73.5, and 79.3%, respectively. The accuracy, sensitivity, and specificity of the risk assessment model in predicting preoperative LNM in GC were 79.3, 80.3, and 79.4%, respectively. Conclusion: Tumor size was the most important factor for evaluating LNM in GC. This decision rules and nomogram model constructed to take into account tumor size, CT findings, grade, hemoglobin, CEA, and CA19-9 effectively predicted the incidence of LNM in preoperative GC.

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“…Many methods have been proposed for the preoperative prediction of lymph node metastases (15,16). However, clinicopathological characteristics such as the macroscopic type, size of tumor, or depth of invasion have mostly been used in these systems without considering the lymphatic flow and pattern of lymph node metastasis (17,18). No.…”

Section: Discussionmentioning

confidence: 99%

Metastatic patterns and surgical methods for lymph nodes No. 5 and No. 6 in proximal gastric cancer

Wang

et al. 2019

Chinese Journal of Cancer Research

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ObjectiveThe current surgical treatment guidelines for early proximal gastric cancer (PGC) still lack agreement. Lymphadenectomy of lymph nodes No. 5 and No. 6 is the major difference between total and proximal gastrectomy. We elucidated the appropriate surgical procedure for PGC by investigating the pathological characteristics and prognostic significance of lymph nodes No. 5 and No. 6.MethodsIn total, 333 PGC patients who underwent total gastrectomy were enrolled in this study. We investigated their clinicopathological characteristics and the metastatic patterns of the lymph nodes. Patients with metastasis in lymph nodes No. 5 and No. 6 were combined into one group and we compared the difference in survival between those with and without metastasis in lymph nodes No. 5, 6 (lymph nodes No. 5 and No. 6 in any group of metastasis) for different subgroups.ResultsThe metastatic rates for lymph nodes No. 5 and No. 6 in PGC were 9.91% and 16.11%, respectively. The metastatic rate for both lymph nodes No. 5, 6 was 20.42%. Multivariate analysis showed that positive metastasis in lymph node No. 4, depth of invasion, and tumor size were independently correlated with the presence of metastasis in lymph nodes No. 5, 6.ConclusionsWhen lymph node No. 4 is positive (intraoperative pathology) or tumor size ≥5 cm or T4 stage, lymphadenectomy should be performed for lymph nodes No. 5 and No. 6, and total gastrectomy is recommended.

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Usefulness of Two-Dimensional Values Measured Using Preoperative Multidetector Computed Tomography in Predicting Lymph Node Metastasis of Gastric Cancer

Abstract: Using two-dimensional values for LNs measured by MDCT is a practical method of predicting metastatic LNs in gastric cancer. The maximal LN area value would be useful in both the preoperative staging and prognosis prediction of gastric cancer.

Cited by 12 publications

References 21 publications

Is Lymph Node Size a Reliable Factor for Estimating Lymph Node Metastasis in Early Gastric Cancer?

Is Lymph Node Size a Reliable Factor for Estimating Lymph Node Metastasis in Early Gastric Cancer?

Establishment of Decision Rules and Risk Assessment Model for Preoperative Prediction of Lymph Node Metastasis in Gastric Cancer

Metastatic patterns and surgical methods for lymph nodes No. 5 and No. 6 in proximal gastric cancer

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