Abstract
Background
The extent of paraaortic lymph node (PAN) metastasis parellels that of distant metastases in patients with biliary carcinoma. Accurate preoperative assessment of PAN metastasis has a crucial impact on surgical indications. In this retrospective study, we evaluated whether computed tomography (CT) scans were useful for diagnosing PAN metastases and excluding patients with PAN metastases from an indication for surgery.
Methods
Between March 1999 and November 2003, 57 patients with biliary carcinoma underwent radical lymphadenectomy or surgical biopsy of PANs. Nine of these patients were diagnosed as having PAN metastasis microscopically. All patients had undergone abdominal CT scans before surgery. To diagnose PAN metastases, we used the following diagnostic criteria. (1) Size; when lymph nodes were greater than 12 mm, 10 mm, 8 mm, or 6 mm in longo or short-axis diameter, the nodes were considered metastatic. (2) Shape and size; when the axial ratio of a lymph node was greater than 0.5, 0.7, 1.0, and the maximum diameter of the long or short axis was greater than 12 mm, 10 mm, 8 mm, or 6 mm, the node was considered metastatic. (3) Internal structure; if the internal structure of a PAN was heterogeneous, the node was considered metastatic. A positive predictive value was calculated for each included criterion when patients numbered ten or more.
Results
Positive predictive values using the above criteria ranged from 13% to 36%. Only one patient had PANs with heterogeneous internal structures.
Conclusions
We were unable to determine surgical indications based on the morphological criteria revealed by a CT scan.
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References
S Kondo Y Nimura N Hayakawa J Kamiya M Nagino K Uesaka (2000) ArticleTitleRegional and para-aortic lymphadenectomy in radical surgery for advanced gallbladder carcinoma Br J Surg 87 418–22 Occurrence Handle10.1046/j.1365-2168.2000.01384.x Occurrence Handle10759735
T Uenishi K Hirohashi S Kubo T Yamamoto O Yamazaki H Kinoshita (2001) ArticleTitleClinicopathological factors predicting outcome after resection of mass-forming intrahepatic cholangiocarcinoma Br J Surg 88 969–74 Occurrence Handle10.1046/j.0007-1323.2001.01784.x Occurrence Handle11442529
Y Kitagawa M Nagino J Kamiya K Uesaka T Sano H Yamamoto et al. (2001) ArticleTitleLymph node metastasis from hilar cholangiocarcinoma: audit of 110 patients who underwent regional and para-aortic node dissection Ann Surg 233 385–92 Occurrence Handle10.1097/00000658-200103000-00013 Occurrence Handle11224627
SM Weber RP DeMatteo Y Fong LH Blumgart WR Jarnagin (2002) ArticleTitleStaging laparoscopy in patients with extrahepatic biliary carcinoma. Analysis of 100 patients Ann Surg 235 392–9 Occurrence Handle10.1097/00000658-200203000-00011 Occurrence Handle11882761
M D’Angelica Y Fong S Weber M Gonen RP DeMatteo K Conlon et al. (2003) ArticleTitleThe role of staging laparoscopy in hepatobiliary malignancy: prospective analysis of 401 cases Ann Surg Oncol 10 183–9 Occurrence Handle10.1245/ASO.2003.03.091 Occurrence Handle12620915
T Ohtani Y Shirai K Tsukada T Muto K Hatakeyama (1996) ArticleTitleSpread of gallbladder carcinoma: CT evaluation with pathologic correlation Abdom Imaging 21 195–201 Occurrence Handle10.1007/s002619900045 Occurrence Handle8661547
N Kokudo M Makuuchi T Natori Y Sakamoto J Yamamoto M Seki et al. (2003) ArticleTitleStrategies for surgical treatment of gallbladder carcinoma based on information available before resection Arch Surg 138 741–50 Occurrence Handle10.1001/archsurg.138.7.741 Occurrence Handle12860755
PB Heller JH Maletano BN Bundy DR Barnhill T Okagaki (1990) ArticleTitleClinical-pathologic study of stage IIB, III, and IVA carcinoma of the cervix: extended diagnostic evaluation for para-aortic node metastasis: Gynecologic Oncology Group study Gynecol Oncol 38 425–30 Occurrence Handle10.1016/0090-8258(90)90085-Y Occurrence Handle2227556
KL Prenzel SP Monig JM Sinning SE Baldus HG Brochhagen PM Schneider et al. (2003) ArticleTitleLymph node size and metastatic infiltration in non-small cell lung cancer Chest 123 463–7 Occurrence Handle10.1378/chest.123.2.463 Occurrence Handle12576367
SP Monig TK Zirbes W Schroder SE Baldus DG Lindemann HP Dienes et al. (1999) ArticleTitleStaging of gastric cancer: correlation of lymph node size and metastatic infiltration AJR Am J Roentgenol 173 365–7 Occurrence Handle10430138
SP Monig SE Baldus TK Zirbes W Schroder DG Lindemann HP Dienes et al. (1999) ArticleTitleLymph node size and metastatic infiltration in colon cancer Ann Surg Oncol 6 579–81 Occurrence Handle10.1007/s10434-999-0579-1 Occurrence Handle10493627
H Kotanagi T Fukuoka Y Shibata T Yoshioka O Aizawa Y Saito et al. (1993) ArticleTitleThe size of lymph nodes does not correlate with the presence or absence of metastasis in lymph nodes in rectal cancer J Surg Oncol 54 252–4 Occurrence Handle8255087
N Doi N Aoyama M Tokunaga M Okamoto M Hayashi Y Kameda et al. (1999) ArticleTitlePossibility of pre-operative diagnosis of lymph node metastasis based on morphology Hepatogastroenterology 46 977–80 Occurrence Handle10370649
T Kato E Tsukamoto Y Kuge C Katoh T Nambu A Nobuta et al. (2002) ArticleTitleClinical role of (18)F-FDG PET for initial staging of patients with extrahepatic bile duct cancer Eur J Nucl Med Mol Imaging 29 1047–54 Occurrence Handle10.1007/s00259-002-0852-z Occurrence Handle12173019
R Kluge F Schmidt K Caca H Barthel S Hesse P Georgi et al. (2001) ArticleTitlePositron emission tomography with [(18)F]fluoro-2-deoxy-d-glucose for diagnosis and staging of bile duct cancer Hepatology 33 1029–35 Occurrence Handle10.1053/jhep.2001.23912 Occurrence Handle11343227
PG Rose LP Adler M Rodriguez PF Faulhaber FW Abdul-Karim F Miraldi (1999) ArticleTitlePositron emission tomography for evaluating para-aortic nodal metastasis in locally advanced cervical cancer before surgical staging: a surgicopathologic study J Clin Oncol 17 41–5 Occurrence Handle10458216
WC Lin YC Hung LS Yeh CH Kao RF Yen YY Shen (2003) ArticleTitleUsefulness of 18F-fluorodeoxyglucose positron emission tomography to detect para-aortic lymph nodal metastasis in advanced cervical cancer with negative computed tomography findings Gynecol Oncol 89 73–6 Occurrence Handle10.1016/S0090-8258(03)00058-1 Occurrence Handle12694656
J Konishi K Yamazaki E Tsukamoto N Tamaki Y Onodera T Otake et al. (2003) ArticleTitleMediastinal lymph node staging by FDG-PET in patients with non-small cell lung cancer: analysis of false-positive FDG-PET findings Respiration 70 500–6 Occurrence Handle10.1159/000074207 Occurrence Handle14665776
CE Reed DH Harpole KE Posther SL Woolson RJ Downey BF Meyers et al. (2003) ArticleTitleAmerican College of Surgeons Oncology Group Z0050 trial. Results of the American College of Surgeons Oncology Group Z0050 trial: the utility of positron emission tomography in staging potentially operable non-small cell lung cancer J Thorac Cardiovasc Surg 126 1943–51 Occurrence Handle10.1016/j.jtcvs.2003.07.030 Occurrence Handle14688710
MG Harisinghani J Barentsz PF Hahn WM Deserno S Tabatabaei CH van de Kaa et al. (2003) ArticleTitleNoninvasive detection of clinically occult lymph-node metastases in prostate cancer N Engl J Med 348 2491–9 Occurrence Handle10.1056/NEJMoa022749 Occurrence Handle12815134
VK Chen MA Eloubeidi (2004) ArticleTitleEndoscopic ultrasound-guided fine needle aspiration is superior to lymph node echofeatures: a prospective evaluation of mediastinal and peri-intestinal lymphadenopathy Am J Gastroenterol 99 628–33 Occurrence Handle10.1111/j.1572-0241.2004.04064.x Occurrence Handle15089893
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Noji, T., Kondo, S., Hirano, S. et al. CT evaluation of paraaortic lymph node metastasis in patients with biliary cancer. J Gastroenterol 40, 739–743 (2005). https://doi.org/10.1007/s00535-005-1618-8
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DOI: https://doi.org/10.1007/s00535-005-1618-8