1
|
Ozaki K, Kurose Y, Kawai K, Kobayashi H, Itabashi M, Hashiguchi Y, Miura T, Shiomi A, Harada T, Ajioka Y. Development of a Diagnostic Artificial Intelligence Tool for Lateral Lymph Node Metastasis in Advanced Rectal Cancer. Dis Colon Rectum 2023; 66:e1246-e1253. [PMID: 37260284 DOI: 10.1097/dcr.0000000000002719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Metastatic lateral lymph node dissection can improve survival in patients with rectal adenocarcinoma, with or without chemoradiotherapy. However, the optimal imaging diagnostic criteria for lateral lymph node metastases remain undetermined. OBJECTIVE To develop a lateral lymph node metastasis diagnostic artificial intelligence tool using deep learning, for patients with rectal adenocarcinoma who underwent radical surgery and lateral lymph node dissection. DESIGN Retrospective study. SETTINGS Multicenter study. PATIENTS A total of 209 patients with rectal adenocarcinoma, who underwent radical surgery and lateral lymph node dissection at 15 participating hospitals, were enrolled in the study and allocated to training (n = 139), test (n = 17), or validation (n = 53) cohorts. MAIN OUTCOME MEASURES In the neoadjuvant treatment group, images taken before pretreatment were classified as baseline images and those taken after pretreatment as presurgery images. In the upfront surgery group, presurgery images were classified as both baseline and presurgery images. We constructed 2 types of artificial intelligence, using baseline and presurgery images, by inputting the patches from these images into ResNet-18, and we assessed their diagnostic accuracy. RESULTS Overall, 124 patients underwent surgery alone, 52 received neoadjuvant chemotherapy, and 33 received chemoradiotherapy. The number of resected lateral lymph nodes in the training, test, and validation cohorts was 2418, 279, and 850, respectively. The metastatic rates were 2.8%, 0.7%, and 3.7%, respectively. In the validation cohort, the precision-recall area under the curve was 0.870 and 0.963 for the baseline and presurgery images, respectively. Although both baseline and presurgery images provided good accuracy for diagnosing lateral lymph node metastases, the accuracy of presurgery images was better than that of baseline images. LIMITATIONS The number of cases is small. CONCLUSIONS An artificial intelligence tool is a promising tool for diagnosing lateral lymph node metastasis with high accuracy. DESARROLLO DE UNA HERRAMIENTA DE INTELIGENCIA ARTIFICIAL PARA EL DIAGNSTICO DE METSTASIS EN GANGLIOS LINFTICOS LATERALES EN CNCER DE RECTO AVANZADO ANTECEDENTES:Disección de nódulos linfáticos laterales metastásicos puede mejorar la supervivencia en pacientes con adenocarcinoma del recto, con o sin quimiorradioterapia. Sin embargo, aún no se han determinado los criterios óptimos de diagnóstico por imágenes de los nódulos linfáticos laterales metastásicos.OBJETIVO:Nuestro objetivo fue desarrollar una herramienta de inteligencia artificial para el diagnóstico de metástasis en nódulos linfáticos laterales mediante el aprendizaje profundo, para pacientes con adenocarcinoma del recto que se sometieron a cirugía radical y disección de nódulos linfáticos laterales.DISEÑO:Estudio retrospectivo.AJUSTES:Estudio multicéntrico.PACIENTES:Un total de 209 pacientes con adenocarcinoma del recto, que se sometieron a cirugía radical y disección de nódulos linfáticos laterales en 15 hospitales participantes, se inscribieron en el estudio y se asignaron a cohortes de entrenamiento (n = 139), prueba (n = 17) o validación (n = 53).PRINCIPALES MEDIDAS DE RESULTADO:En el grupo de tratamiento neoadyuvante, las imágenes tomadas antes del tratamiento se clasificaron como imágenes de referencia y las posteriores al tratamiento, como imágenes previas a la cirugía. En el grupo de cirugía inicial, las imágenes previas a la cirugía se clasificaron como imágenes de referencia y previas a la cirugía. Construimos dos tipos de inteligencia artificial, utilizando imágenes de referencia y previas a la cirugía, ingresando los parches de estas imágenes en ResNet-18. Evaluamos la precisión diagnóstica de los dos tipos de inteligencia artificial.RESULTADOS:En general, 124 pacientes se sometieron a cirugía solamente, 52 recibieron quimioterapia neoadyuvante y 33 recibieron quimiorradioterapia. El número de nódulos linfáticos laterales removidos en los cohortes de entrenamiento, prueba y validación fue de 2,418; 279 y 850, respectivamente. Las tasas metastásicas fueron 2.8%, 0.7%, y 3.7%, respectivamente. En el cohorte de validación, el área de recuperación de precisión bajo la curva fue de 0.870 y 0.963 para las imágenes de referencia y antes de la cirugía, respectivamente. Aunque tanto las imágenes previas a la cirugía como las iniciales proporcionaron una buena precisión para diagnosticar metástasis en los nódulos linfáticos laterales, la precisión de las imágenes previas a la cirugía fue mejor que la de las imágenes iniciales.LIMITACIONES:El número de casos es pequeño.CONCLUSIÓN:La inteligencia artificial es una herramienta prometedora para diagnosticar metástasis en los nódulos linfáticos laterales con alta precisión. (Traducción-Dr. Aurian Garcia Gonzalez ).
Collapse
Affiliation(s)
- Kosuke Ozaki
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yusuke Kurose
- Research Center for Advanced Science and Technology, University of Tokyo, Tokyo, Japan
- Center for Advanced Intelligence Project, RIKEN, Tokyo, Japan
| | - Kazushige Kawai
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | | | - Michio Itabashi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yojiro Hashiguchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takuya Miura
- Department of Gastroenterological Surgery, Hirosaki University, Graduate School of Medicine, Aomori, Japan
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tatsuya Harada
- Research Center for Advanced Science and Technology, University of Tokyo, Tokyo, Japan
- Center for Advanced Intelligence Project, RIKEN, Tokyo, Japan
- Research Center for Medical Bigdata, National Institute of Informatics, Tokyo, Japan
| | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| |
Collapse
|
2
|
Zhang C, Cui M, Xing J, Yang H, Yao Z, Zhang N, Tan F, Liu M, Xu K, Su X. Effect of lateral lymph nodes without malignant characteristics on the prognosis of patients with rectal cancer. Future Oncol 2022; 18:3509-3518. [PMID: 36317561 DOI: 10.2217/fon-2022-0476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Lateral lymph node (LLN) metastasis is a poor prognostic factor for rectal cancer patients. However, the effect of LLNs without malignant characteristics on the prognosis of rectal cancer patients has been uncertain. Methods: Consecutive patients who underwent laparoscopic-assisted low anterior resection were included. Patients with MRI-detected LLNs, but without malignant characteristics, were compared with patients with no MRI-detected LLNs. Results: The local recurrence rate was higher in the LLN-present group than in the LLN-absent group (9.8% vs 2.5%; p = 0.056). The overall survival of patients with no MRI-detected LLNs was significantly better than that of patients with MRI-detected LLNs (p = 0.021). Conclusion: The presence of LLNs, even without malignant features, may lead to worse local control and overall survival.
Collapse
Affiliation(s)
- Chenghai Zhang
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China
| | - Ming Cui
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China
| | - Jiadi Xing
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China
| | - Hong Yang
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China
| | - Zhendan Yao
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China
| | - Nan Zhang
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China
| | - Fei Tan
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China
| | - Maoxing Liu
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China
| | - Kai Xu
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China
| | - Xiangqian Su
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fu-Cheng Road, Hai-Dian District, Beijing, 100142, China
| |
Collapse
|
3
|
Suzuki Y, Sasaki T, Hasegawa H, Ikeda K, Teramura K, Tsukada Y, Nishizawa Y, Ito M. Morphological characteristics of lateral pelvic lymph nodes in locally advanced lower rectal cancer: A retrospective study. Ann Gastroenterol Surg 2022; 6:795-803. [PMID: 36338594 PMCID: PMC9628236 DOI: 10.1002/ags3.12590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 05/30/2022] [Indexed: 02/09/2023] Open
Abstract
AIM This study aimed to investigate the potential of the size and aspect ratio of metastatic and non-metastatic lateral pelvic lymph nodes (LPLNs) as low-risk markers for locally advanced lower rectal cancer, without treatment by neoadjuvant chemoradiation therapy or LPLN dissection. METHODS This single-center, retrospective cohort study evaluated 310 consecutive patients diagnosed with lower rectal cancer (T: T3/T4, N: any, and M: M0) who underwent curative surgery without neoadjuvant therapies between 2010 and 2018. The harvested LPLNs were categorized into groups A (metastasis-positive lymph nodes), B (metastasis-negative lymph nodes in the area bearing metastasis-positive lymph nodes), C (metastasis-negative lymph nodes in a metastasis-negative area in metastasis-positive patients), and D (lymph nodes in non-metastatic patients). The main outcome measure was the relationship among lymph node size, aspect ratio, and metastasis in the LPLNs. RESULTS Overall, 3962 LPLNs were harvested. The long and short axes and the aspect ratio were significantly longer and higher, respectively, in group A than in the other groups (P < .001). The aspect ratio in group B was significantly higher than that in groups C and D (P < .001). The aspect ratio in group C was significantly higher than that in group D (P < .001). Furthermore, no metastasis-positive lymph nodes had an aspect ratio of less than 0.4. Metastasis-positive LPLNs tended to be larger and rounder than their metastasis-negative counterparts. CONCLUSIONS Metastatic LPLNs in patients with lower rectal cancer are significantly larger and have a higher aspect ratio. Lymph nodes with aspect ratios of <0.4 were metastasis negative.
Collapse
Affiliation(s)
- Yushi Suzuki
- Department of Colorectal SurgeryNational Cancer Center Hospital EastChibaJapan
| | - Takeshi Sasaki
- Department of Colorectal SurgeryNational Cancer Center Hospital EastChibaJapan
| | - Hiro Hasegawa
- Department of Colorectal SurgeryNational Cancer Center Hospital EastChibaJapan
| | - Koji Ikeda
- Department of Colorectal SurgeryNational Cancer Center Hospital EastChibaJapan
| | - Koichi Teramura
- Department of Colorectal SurgeryNational Cancer Center Hospital EastChibaJapan
| | - Yuichiro Tsukada
- Department of Colorectal SurgeryNational Cancer Center Hospital EastChibaJapan
| | - Yuji Nishizawa
- Department of Colorectal SurgeryNational Cancer Center Hospital EastChibaJapan
| | - Masaaki Ito
- Department of Colorectal SurgeryNational Cancer Center Hospital EastChibaJapan
| |
Collapse
|
4
|
Establishment and validation of a nomogram for predicting potential lateral pelvic lymph node metastasis in low rectal cancer. Int J Clin Oncol 2022; 27:1173-1179. [PMID: 35415787 DOI: 10.1007/s10147-022-02157-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 03/11/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Identifying lateral pelvic lymph node (LPN) metastasis in low rectal cancer is crucial before treatment. Several risk factors and prediction models for LPN metastasis have been reported. However, there is no useful tool to accurately predict LPN metastasis. Therefore, we aimed to construct a nomogram for predicting LPN metastasis in rectal cancer. METHODS We analyzed the risk factors for potential LPN metastasis by logistic regression analysis in 705 patients who underwent primary resection of low rectal cancer. We included patients at 49 institutes of the Japan Society of Laparoscopic Colorectal Surgery between June 2010 and February 2012. Clinicopathological factors and magnetic resonance imaging findings were evaluated. The nomogram performance was assessed using the c-index and calibration plots, and the nomogram was validated using an external cohort. RESULTS In the univariable logistic regression analysis, age, sex, carcinoembryonic antigen, tumor location, clinical T stage, tumor size, circumferential resection margin (CRM), extramural vascular invasion (EMVI), and the short and long axes of LPN and perirectal lymph node (PRLN) were nominated as risk factors for potential LPN metastasis. We identified a combination of the short axis of LPN, tumor location, EMVI, and short axis of PRLN as optimal for predicting potential LPN metastasis and developed a nomogram using these factors. This model had a c-index of 0.74 and was moderately calibrated and well-validated. CONCLUSIONS This is the first study to construct a well-validated nomogram for predicting potential LPN metastasis in rectal cancer, and its performance was high.
Collapse
|
5
|
Amano K, Fukuchi M, Kumamoto K, Hatano S, Ohno H, Osada H, Ishibashi K, Ishida H. Pre-operative Evaluation of Lateral Pelvic Lymph Node Metastasis in Lower Rectal Cancer: Comparison of Three Different Imaging Modalities. JOURNAL OF THE ANUS RECTUM AND COLON 2020; 4:34-40. [PMID: 32002474 PMCID: PMC6989126 DOI: 10.23922/jarc.2019-022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/30/2019] [Indexed: 01/04/2023]
Abstract
Objectives: The pre-operative diagnostic value of detecting lateral pelvic lymph node (LPLN) metastasis with magnetic resonance imaging, multidirectory computed tomography, and positron emission tomography/computed tomography was investigated in lower rectal cancer patients. Methods: We retrospectively evaluated, using the three different modalities, the metastatic status of LPLNs in four regions, including both the internal iliac and the obturator, in 46 patients affected by lower rectal cancer patients who underwent LPLN dissection. The size inclusion criterion for LPLN metastasis was set at 6 mm in the short axis diameter. Histological examination was performed for determining the false positive and negative rate of LPLNs metastasis detection. Results: Among 184 LPLNs regions, 17 (9%) were positive for metastasis. The region-based sensitivity, specificity, and accuracy rate did not differ among the three tested diagnostic modalities. Moreover, a significant increase in these rates could not be observed when the modalities were combined. Of 184 regions, 8 (4.4%) were false negative, whereas 2 (1.1%) were false positive. The histological pattern of metastatic regions did not differ in 8 false negative LPLNs. Conclusions: Each modality had a similar detection power for LPLNs metastasis, with a cut-off value at 6 mm in the short axis diameter. However, the sensitivity of all the modalities was slightly low, along with the number of false negative LPLNs. Further reduction of the false negative rate with these modalities may be difficult because of an inherent limitation of current imaging technologies to accurately detect lymph node metastases.
Collapse
Affiliation(s)
- Kunihiko Amano
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Minoru Fukuchi
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Kensuke Kumamoto
- Department of Gastroenterological Surgery, Kagawa University, Kagawa, Japan
| | - Satoshi Hatano
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Hitoshi Ohno
- Department of Radiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Hisato Osada
- Department of Radiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Keiichiro Ishibashi
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Hideyuki Ishida
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| |
Collapse
|
6
|
Utility of Preoperative Imaging for Predicting Pelvic Lateral Lymph Node Metastasis in Lower Rectal Cancer. Indian J Surg Oncol 2019; 10:582-586. [DOI: 10.1007/s13193-019-00947-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/21/2019] [Indexed: 12/20/2022] Open
|
7
|
Hoshino N, Murakami K, Hida K, Sakamoto T, Sakai Y. Diagnostic accuracy of magnetic resonance imaging and computed tomography for lateral lymph node metastasis in rectal cancer: a systematic review and meta-analysis. Int J Clin Oncol 2018; 24:46-52. [DOI: 10.1007/s10147-018-1349-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/23/2018] [Indexed: 12/23/2022]
|
8
|
Preoperative chemoradiotherapy changes the size criterion for predicting lateral lymph node metastasis in lower rectal cancer. Int J Colorectal Dis 2017; 32:1631-1637. [PMID: 28762190 DOI: 10.1007/s00384-017-2873-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to identify the size criteria of lateral lymph node metastasis in lower rectal cancer both in patients who underwent preoperative CRT and those who did not. METHODS This study enrolled 150 patients who underwent resection for primary lower rectal adenocarcinoma with lateral lymph node dissection between 2013 and 2015. Patients were divided into two groups: the CRT group, treated with preoperative chemoradiotherapy before surgery, and the non-CRT group, treated with surgery alone. The short-axis diameter of each dissected lateral lymph node was measured. Receiver-operating characteristic curves were generated to reveal the optimal cutoff values for determining lateral lymph node metastasis in both groups. RESULTS In the non-CRT group (n = 131), the ROC curve demonstrated that the optimal cutoff value for determining metastasis was 6.0 mm, with a sensitivity of 78.5% and specificity of 82.9%, and the AUC was 0.845. In comparison, in the CRT group (n = 19), the optimal cutoff value was 5.0 mm, with a sensitivity of 71.4% and specificity of 85.3% and an AUC of 0.836. CONCLUSION The cutoff size for determining lateral lymph node metastasis was smaller in the CRT group than in the non-CRT group.
Collapse
|
9
|
Smereka P, Doshi AM, Ream JM, Rosenkrantz AB. The American College of Radiology Incidental Findings Committee Recommendations for Management of Incidental Lymph Nodes: A Single-Center Evaluation. Acad Radiol 2017; 24:603-608. [PMID: 28169142 DOI: 10.1016/j.acra.2016.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 12/12/2016] [Indexed: 12/21/2022]
Abstract
RATIONALE AND OBJECTIVES To assess the American College of Radiology Incidental Findings Committee's (ACR-IFC) recommendations for defining and following up abnormal incidental abdominopelvic lymph nodes. MATERIALS AND METHODS A total of 59 lymph nodes satisfying ACR-IFC criteria as incidental (no malignancy or lymphoproliferative disorder) and with sufficient follow-up to classify as benign (biopsy, decreased size, ≥12-month stability) or malignant (biopsy, detection of primary malignancy combined with either fluorodeoxyglucose hyperactivity or increase in size of the node) were included. Two radiologists independently assessed nodes for suspicious features by ACR-IFC criteria (round with indistinct hilum, hypervascularity, necrosis, cluster ≥3 nodes, cluster ≥2 nodes in ≥2 stations, size ≥1 cm in retroperitoneum). Outcomes were assessed with attention to ACR-IFC's recommendation for initial 3-month follow-up. RESULTS A total of 8.5% of nodes were malignant; 91.5% were benign. Two of six malignant nodes were stable at 3 to <6-month follow-up before diagnosis; diagnosis of four of five malignant nodes was facilitated by later development of non-nodal sites of tumor. A total of 13, 5, 8, and 9 nodes were deemed benign given a decrease at <3 months, 3-5 months, 6-11 months, or ≥12 months of follow-up. No ACR-IFC feature differentiated benign and malignant nodes (P = 0.164-1.0). A cluster ≥3 nodes was present in 88.1%-93.2% of nodes. A total of 96.6%-98.3% had ≥1 suspicious feature for both readers. Necrosis and hypervascularity were not identified in any node. CONCLUSIONS ACR-IFC imaging features overwhelmingly classified incidental nodes as abnormal, although did not differentiate benign and malignant nodes. Nodes stable at the ACR-IFC's advised initial 3-month follow-up were occasionally proven malignant or decreased on further imaging. Refinement of imaging criteria to define nodes of particularly high risk, integrated with other clinical criteria, may help optimize the follow-up of incidental abdominopelvic lymph nodes.
Collapse
|
10
|
Yamaoka Y, Kinugasa Y, Shiomi A, Yamaguchi T, Kagawa H, Yamakawa Y, Furutani A, Numata M. Is it important to palpate lymph nodes in open surgery for colorectal cancer? Asian J Endosc Surg 2017; 10:143-147. [PMID: 27863086 DOI: 10.1111/ases.12340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/16/2016] [Accepted: 09/25/2016] [Indexed: 01/22/2023]
Abstract
INTRODUCTION In laparoscopic or robotic surgery, surgeons cannot directly palpate lymph nodes (LN), which could be considered a shortcoming in that procedure. This study was performed to evaluate the importance of palpation diagnosis of LN metastasis in colorectal cancer surgery. METHODS This study enrolled 408 patients who underwent curative resection for primary colorectal cancer in our department in 2014. The diameter of each manually dissected LN was measured, and the LN was then examined by palpation to determine whether it was metastatic based on its consistency. The palpation and pathological diagnoses of each LN were compared. Sensitivities, specificities, positive predictive values, negative predictive values, and accuracies were calculated for palpation diagnosis of LN metastasis in a node-by-node analysis, according to LN size. RESULTS Of the 13 750 dissected LN, 444 LN (3.2%) were metastatic. Overall, palpation diagnosis of LN metastasis revealed node-by-node sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 50%, 98%, 52%, 98%, and 97%, respectively. The sensitivity for LN 3 mm and smaller and for LN 15 mm and larger was 3% and 90%, respectively. CONCLUSION Palpation diagnosis of LN metastasis in colorectal cancer surgery was unreliable. Although poor haptics is considered to be a disadvantage in laparoscopic and robotic surgery, they are not inferior to open surgery in terms of LN dissection.
Collapse
Affiliation(s)
- Yusuke Yamaoka
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yusuke Kinugasa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Tomohiro Yamaguchi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Hiroyasu Kagawa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yushi Yamakawa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Akinobu Furutani
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Masakatsu Numata
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| |
Collapse
|
11
|
Chen C, Zhang M, Xu Y, Yue Q, Bai P, Zhou L, Xiao Y, Zheng D, Lin K, Qiu S, Chen Y, Pan J. Unidimensional Measurement May Evaluate Target Lymph Nodal Response After Induction Chemotherapy for Nasopharyngeal Carcinoma. Medicine (Baltimore) 2016; 95:e2667. [PMID: 26945354 PMCID: PMC4782838 DOI: 10.1097/md.0000000000002667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of the study was to evaluate whether short axis and long axis on axial and coronal magnetic resonance imaging planes would reflect the tumor burden or alteration in size after induction chemotherapy in nasopharyngeal carcinoma. Patients with pathologically confirmed nasopharyngeal carcinoma (n = 37) with at least 1 positive cervical lymph node (axial short axis ≥15 mm) were consecutively enrolled in this prospective study. Lymph nodal measurements were performed along its short axis and long axis in both axial and coronal magnetic resonance imaging planes at diagnosis and after 2 cycles of induction chemotherapy. In addition, lymph nodal volumes were automatically calculated in 3D treatment-planning system, which were used as reference standard. Student's t test or nonparametric Mann-Whitney U test was used to compare the continuous quantitative variables. Meanwhile, the κ statistic and McNemar's test were used to evaluate the degree of agreement and discordance in response categorization among different measurements. Axial short axis was significantly associated with volumes at diagnosis (P < 0.001). A good agreement (κ=0.583) was found between axial short axis and volumetric criteria. However, the inconsistent lymph nodal shrinkage in 4 directions was observed. Axial short-axis shrinking was more rapid than the other 3 parameters. Interestingly, when utilizing the alternative planes for unidimensional measurements to assess tumor response, coronal short-axis showed the best concordance (κ=0.792) to the volumes. Axial short axis may effectively reflect tumor burden or change in tumor size in the assessment of target lymph nodal response after induction chemotherapy for nasopharyngeal carcinoma. However, it should be noted that axial short axis may amplify the therapeutic response. In addition, the role of coronal short axis in the assessment of tumor response needs further evaluation.
Collapse
Affiliation(s)
- Chuanben Chen
- From the Department of Radiation Oncology (CC, MZ, YX, PB, LZ, SQ, JP), Fujian Provincial Cancer Hospital; The Shengli Clinical Medical College of Fujian Medical University (CC, MZ, YX, QY, LZ, YX, DZ, KL, SQ, YC, JP); and Department of Radiology (QY, YX, DZ, KL, YC), Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People's Republic of China
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Kim TH, Lim MC, Kim SI, Seo SS, Kim SH, Park SY. Preoperative Prediction of Cardiophrenic Lymph Node Metastasis in Advanced Ovarian Cancer Using Computed Tomography. Ann Surg Oncol 2015; 23:1302-8. [PMID: 26714941 DOI: 10.1245/s10434-015-5015-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether the preoperative diameter of cardiophrenic lymph nodes (CPLNs) along the short and long axes, determined via computed tomography (CT), predicts CPLN metastasis in patients with advanced epithelial ovarian cancer. METHODS A total of 31 patients with primary advanced ovarian cancer who had CPLN dissection underwent preoperative CT that was reviewed twice by a radiologist blinded to the final pathology. An array of CT features and clinical factors [age, cancer antigen 125 (CA 125)] were compared between metastasis-positive and metastasis-negative CPLNs using the t test and Fisher's exact test. The optimal CPLN dimensions that best predicted metastasis were calculated using a receiver operating characteristic (ROC) curve, and were applied to find the correlation with other CT findings. Results were validated in an independent test set of nine patients by using the best cutoff value to predict metastasis. RESULTS Pathological evaluation revealed metastasis-positive CPLNs in 19 patients and metastasis-negative CPLNs in 12 patients. Metastasis-positive CPLNs had significantly reduced short axes than those of negative CPLNs (5.6 ± 1.7 and 7.8 ± 2.2, respectively; p < 0.001). ROC curve analysis showed that a cutoff value of 7 mm for the short axis demonstrated the largest area under the curve (0.789; p < 0.0007), with 63.16 % sensitivity and 83.33 % specificity. The presence of peritoneal metastasis and abdominopelvic adenopathy strongly related with CPLN adenopathy. Accuracies were 66.7 % (six of nine patients) based on the cutoff value in the independent test set. CONCLUSIONS The probability of detecting CPLN metastasis in patients with advanced ovarian cancer was approximately 85 % when the short axis of the CPLN was >7 mm in preoperative CT scans. Patients with CPLNs of this size may be candidates for CPLN dissection in order to confirm the pathological diagnosis.
Collapse
Affiliation(s)
- Tae-Hyung Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Myong Cheol Lim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Republic of Korea. .,Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea. .,Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Seoul, Republic of Korea.
| | - Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-Soo Seo
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Republic of Korea
| | - Sun Ho Kim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Republic of Korea
| | - Sang-Yoon Park
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Republic of Korea. .,Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea.
| |
Collapse
|
13
|
Kim MJ, Kim TH, Kim DY, Kim SY, Baek JY, Chang HJ, Park SC, Park JW, Oh JH. Can chemoradiation allow for omission of lateral pelvic node dissection for locally advanced rectal cancer? J Surg Oncol 2015; 111:459-64. [PMID: 25559888 DOI: 10.1002/jso.23852] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 11/06/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We evaluated the relationship between pretreatment clinical parameters and lateral pelvic node (LPN) recurrence in patients with rectal cancer treated with a combination of curative resection and chemoradiotherapy (CRT) and attempted to identify the patients who might benefit from LPN dissection. METHODS This study involved 900 patients between June 2001 and June 2009. Pretreatment clinical parameters including radiological size of LPN were analyzed to identify risk factors associated with long-term outcomes. RESULTS Locoregional recurrence developed in 65 patients (7.2%); 42 (64.6%) had LPN recurrence, 20 (47.6%) of which had no distant metastasis. Multivariate analysis showed that LPN short-axis diameter (<5, 5-<10, and ≥10 mm) was significantly associated with LPN recurrence-free survival (5-year survival rate (5YSR), 98.2, 91.7, and 40.1%, respectively, P < 0.05), locoregional recurrence-free survival (5YSR, 95.5, 87.6, and 40.1%, respectively, P < 0.05), relapse-free survival (5YSR, 76.8, 72.5, and 30.3, respectively, P < 0.05), and overall survival (5YSR, 86.3, 83.0, and 57.5%, respectively, P < 0.05). CONCLUSIONS Patients with an LPN short-axis diameter ≥10 mm represent a potential subgroup at a high risk of LPN recurrence, even after CRT. Further study is needed to confirm whether LPN dissection is beneficial for these patients.
Collapse
Affiliation(s)
- Min Ju Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Republic of Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Hatano S, Ishida H, Ishiguro T, Kumamoto K, Ishibashi K, Mochiki E, Tamaru J. Prediction of metastasis to mesorectal, internal iliac and obturator lymph nodes according to size criteria in patients with locally advanced lower rectal cancer. Jpn J Clin Oncol 2014; 45:35-42. [PMID: 25324477 DOI: 10.1093/jjco/hyu162] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE This study was performed to clarify whether size criteria could be applied to the prediction of metastasis to the mesorectal, internal iliac and obturator lymph nodes in patients with lower rectal cancer. METHODS A total of 915 lymph nodes (416 mesorectal, 199 internal iliac and 300 obturator) from 53 patients with lower rectal cancer who underwent a curative resection were examined; 83 lymph nodes were positive. The sizes of the lymph nodes immediately after removal and those of paraffin-embedded sections were compared for 175 lymph nodes. Then, size criteria for discriminating the status of metastasis were evaluated in 915 paraffin-embedded lymph nodes. RESULTS Regardless of the metastatic status and the site of the lymph nodes, a positive relationship was observed between the sizes of the lymph nodes immediately after removal and those of paraffin-embedded sections (P < 0.01). The area under the curve generated by a receiver-operating characteristics curve showed no significant differences between the short-axis diameter and the long-axis diameter, regardless of the lymph node location. Specifically, the optimal cutoff value of the short-axis diameter for discriminating the status of metastasis in mesorectal, internal iliac and obturator lymph nodes extrapolated to the living body was set at 6.2, 5.0 and 4.8 mm, with accuracies of 72.4, 63.8 and 59.3% and with positive predictive values of 29.9, 16.3 and 7.1%, respectively. CONCLUSIONS Size criteria were applicable for discriminating the metastatic status of lymph nodes from three different locations, although the positive predictive values of the size criteria for the internal iliac and obturator lymph nodes were lower than that for the mesorectal lymph nodes.
Collapse
Affiliation(s)
- Satoshi Hatano
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe
| | - Hideyuki Ishida
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe
| | - Tohru Ishiguro
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe
| | - Kensuke Kumamoto
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe
| | - Keiichiro Ishibashi
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe
| | - Erito Mochiki
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe
| | - Junichi Tamaru
- Department of Pathology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| |
Collapse
|
15
|
Coupe NA, Karikios D, Chong S, Yap J, Ng W, Merrett N, Lin M. Metabolic information on staging FDG-PET-CT as a prognostic tool in the evaluation of 97 patients with gastric cancer. Ann Nucl Med 2013; 28:128-35. [PMID: 24297388 DOI: 10.1007/s12149-013-0791-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 11/10/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVE Gastric cancer remains a leading cause of malignancy-related mortality. Many patients with locally advanced disease succumb despite peri-operative chemotherapy and the survival benefit of chemotherapy for advanced disease is modest, suggesting that current staging is imperfect. The role of fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in the staging of gastric cancer remains to be determined. This study aimed to determine, and compare with computerized tomography (CT), the association between FDG-PET uptake in the primary tumour and regional lymph nodes, and overall survival in patients with all stage gastric cancer. METHODS Patients with histologically confirmed gastric cancer (any stage) who, at diagnosis, had received a staging FDG-PET-CT at our institution between 2006 and 2011 were included. Records were retrospectively analysed. Patients with >50 % of tumour above the gastro-oesophageal junction or an active second malignancy were excluded. RESULTS 97 patients were included in the analysis. Surgery with curative intent was performed in 68 patients. In univariate analysis, an association with overall survival was seen in patients who had FDG-PET-positive primary tumours (hazard ratio (HR) for death 3.33, 95 % confidence interval (95 % CI) 1.63-6.80, p = 0.001). FDG-PET lymph node positive (vs node negativity) was associated with inferior overall survival (HR 8.66, 95 % CI 4.59-16.37, p < 0.0001), and remained an independent predictor in the multivariate analysis. In contrast, positive lymphadenopathy identified on CT was not associated with overall survival (HR 1.34, 95 % CI 0.79-2.29, p = 0.82). CONCLUSION FDG-PET-positive tumours are associated with an inferior overall survival. In contrast to CT, FDG-PET-positive lymphadenopathy is associated with a decreased overall survival.
Collapse
Affiliation(s)
- Nicholas A Coupe
- Department of Medical Oncology, Liverpool Hospital, Sydney, NSW, Australia,
| | | | | | | | | | | | | |
Collapse
|
16
|
Heller MT, Harisinghani M, Neitlich JD, Yeghiayan P, Berland LL. Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 3: White Paper of the ACR Incidental Findings Committee II on Splenic and Nodal Findings. J Am Coll Radiol 2013; 10:833-9. [DOI: 10.1016/j.jacr.2013.05.020] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 05/24/2013] [Indexed: 12/27/2022]
|
17
|
Ishida H, Hatano S, Ishiguro T, Kumamoto K, Ishibashi K, Haga N. Prediction of lateral lymph node metastasis in lower rectal cancer: analysis of paraffin-embedded sections. Jpn J Clin Oncol 2012; 42:485-90. [PMID: 22457325 DOI: 10.1093/jjco/hys041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE In the surgical treatment for lower rectal cancer, preoperative selection of patients at high risk for lateral lymph node metastasis is important, since lateral lymph node dissection might impair genitourinary functions. We examined whether the status of lateral lymph node metastasis can be predicted from the lymph node size. METHODS The subjects were 533 (35 positive and 498 negative) lateral lymph nodes from 47 patients with lower rectal cancer who underwent curative resection with lateral lymph node dissection. The sizes of the lateral lymph nodes immediately after removal and those in paraffin-embedded sections were compared for 108 lateral lymph nodes from 13 patients. In addition, receiver-operating characteristic curves were generated for the 533 paraffin-embedded lateral lymph nodes from the 47 patients to determine the optimal cut-off size for discriminating between positive and negative lateral lymph nodes. RESULTS Irrespective of the presence/absence of metastasis and the long-/short-axis diameter, a positive relationship was noted between the sizes of the lateral lymph nodes measured immediately after removal and those measured on paraffin-embedded sections (P< 0.01). The area under the curve for the short-axis diameter differed little from that for the long-axis diameter (0.77 vs. 0.76, P =0.80). The optimal cut-off values of the short- and long-axis diameter extrapolated to the living body were 5.4 and 8.4 mm, respectively, with an accuracy of 72.8% for the short-axis diameter and 71.9% for the long-axis diameter. CONCLUSIONS Prediction of the status of lateral lymph node metastasis from the lymph node size (long-/short-axis diameter) may be a simple and reliable method. The optimal cut-off diameter should be validated in prospective imaging studies.
Collapse
Affiliation(s)
- Hideyuki Ishida
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, Japan.
| | | | | | | | | | | |
Collapse
|
18
|
Gleeson FC, Clain JE, Rajan E, Topazian MD, Wang KK, Levy MJ. EUS-FNA assessment of extramesenteric lymph node status in primary rectal cancer. Gastrointest Endosc 2011; 74:897-905. [PMID: 21839439 DOI: 10.1016/j.gie.2011.05.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 05/21/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND Preoperative staging is an essential factor in the multidisciplinary management of rectal cancer. The accuracy of imaging alone with CT, magnetic resonance imaging, or rigid endorectal US is poor. The addition of EUS-FNA may enhance extramesenteric lymph node metastases detection (M1 disease) and overall staging accuracy. OBJECTIVE To evaluate the frequency of extramesenteric lymph node visualization by EUS and the rate of extramesenteric lymph node metastases by FNA. Secondary goals were to evaluate the clinical, endoscopic, and sonographic features associated with extramesenteric lymph node metastases, disease progression, and overall mortality. DESIGN Retrospective cohort study. SETTINGS Tertiary referral center. RESULTS Forty-one of 316 patients (13%) with primary rectal cancer over a 6-year period had M1 disease by EUS-FNA. Significant clinical, endoscopic, and sonographic features associated with extramesenteric lymph node metastases included the serum carcinoembryonic antigen level, tumor length 4 cm and longer, annularity 50% or more, sessile morphology, and lymph node size. The sensitivity and specificity of CT for extramesenteric lymph node metastases were 44% and 89%, respectively. Twenty-three of 316 rectal cancer endosonographic procedures (7.3%) were up-staged by FNA, which established extramesenteric lymph node metastases. Over a 4-year follow-up, disease progression and overall mortality of patients with extramesenteric lymph node metastases was observed in 6 patients (14.6%) and 14 patients (34%), respectively. CONCLUSIONS Preoperative EUS-FNA identification of extramesenteric lymph node metastases outside of standard radiation fields or total mesorectal excision resection margins could affect medical and surgical planning.
Collapse
Affiliation(s)
- Ferga C Gleeson
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | | | | | | | | |
Collapse
|
19
|
Dharmarajan S, Shuai D, Fajardo AD, Birnbaum EH, Hunt SR, Mutch MG, Fleshman JW, Lin AY. Clinically enlarged lateral pelvic lymph nodes do not influence prognosis after neoadjuvant therapy and TME in stage III rectal cancer. J Gastrointest Surg 2011; 15:1368-74. [PMID: 21533959 DOI: 10.1007/s11605-011-1533-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 04/01/2011] [Indexed: 01/31/2023]
Abstract
PURPOSE The significance of lateral pelvic lymph nodes (LPLN) in rectal cancer remains unclear. The purpose of this study was to determine the outcome of patients with LPLNs identified on pretherapy imaging who were treated with neoadjuvant therapy followed by proctectomy without LPLN dissection. METHODS Pretherapy imaging of patients with stage III rectal cancer was reviewed to determine perirectal and LPLN enlargement. Data were collected on preoperative therapy, operative resection, adjuvant therapy, and patient outcomes and were correlated to the presence or absence of preoperatively identified LPLNs (LPLN+ and LPLN-). RESULTS Of the 53 patients identified who were treated between 2000 and 2005, 30 (57%) were LPLN+ on preoperative imaging. All patients received preoperative radiation therapy and total mesorectal excision. The local recurrence was 13%, and there was no difference related to LPLN status. A comparison of the overall and disease-free survival in patients with and without enlarged LPLNs revealed no difference. CONCLUSIONS The LPLNs that were identified on pretherapy imaging do not affect the overall or disease-free survival after the neoadjuvant therapy and proctectomy in stage III rectal cancer. A lateral pelvic lymph node dissection does not appear to be justified in stage III patients with LPLNs on pretherapy imaging who receive neoadjuvant therapy.
Collapse
Affiliation(s)
- Sekhar Dharmarajan
- Department of Surgery, Washington University School of Medicine, Campus Box 8109, 660 South Euclid Avenue, St. Louis, MO, USA,
| | | | | | | | | | | | | | | |
Collapse
|
20
|
van Persijn van Meerten EL, Gelderblom H, Bloem JL. RECIST revised: implications for the radiologist. A review article on the modified RECIST guideline. Eur Radiol 2009; 20:1456-67. [PMID: 20033179 PMCID: PMC2872013 DOI: 10.1007/s00330-009-1685-y] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 11/03/2009] [Accepted: 11/06/2009] [Indexed: 12/21/2022]
Abstract
The purpose of this review article is to familiarize radiologists with the recently revised Response Evaluation Criteria in Solid Tumours (RECIST), used in many anticancer drug trials to assess response and progression rate. The most important modifications are: a reduction in the maximum number of target lesions from ten to five, with a maximum of two per organ, with a longest diameter of at least 10 mm; in lymph nodes (LNs) the short axis rather than the long axis should be measured, with normal LN measuring <10 mm, non-target LN ≥10 mm but <15 mm and target LN ≥15 mm; osteolytic lesions with a soft tissue component and cystic tumours may serve as target lesions; an additional requirement for progressive disease (PD) of target lesions is not only a ≥20% increase in the sum of the longest diameter (SLD) from the nadir but also a ≥5 mm absolute increase in the SLD (the other response categories of target lesion are unchanged); PD of non-target lesions can only be applied if the increase in non-target lesions is representative of change in overall tumour burden; detailed imaging guidelines. Alternative response criteria in patients with hepatocellular carcinoma and gastrointestinal stromal tumours are discussed.
Collapse
|
21
|
Schwartz LH, Bogaerts J, Ford R, Shankar L, Therasse P, Gwyther S, Eisenhauer EA. Evaluation of lymph nodes with RECIST 1.1. Eur J Cancer 2008; 45:261-7. [PMID: 19091550 DOI: 10.1016/j.ejca.2008.10.028] [Citation(s) in RCA: 184] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 10/29/2008] [Indexed: 12/14/2022]
Abstract
Lymph nodes are common sites of metastatic disease in many solid tumours. Unlike most metastases, lymph nodes are normal anatomic structures and as such, normal lymph nodes will have a measurable size. Additionally, the imaging literature recommends that lymph nodes be measured in the short axis, since the short axis measurement is a more reproducible measurement and predictive of malignancy. Therefore, the RECIST committee recommends that lymph nodes be measured in their short axis and proposes measurement values and rules for categorising lymph nodes as normal or pathologic; either target or non-target lesions. Data for the RECIST warehouse are presented to demonstrate the potential change in response assessment following these rules. These standardised lymph node guidelines are designed to be easy to implement, focus target lesion measurements on lesions that are likely to be metastatic and prevent false progressions due to minimal change in size.
Collapse
Affiliation(s)
- L H Schwartz
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue (C-276D), New York, NY, USA.
| | | | | | | | | | | | | |
Collapse
|