Bedeutung der CT für die Beurteilung regionärer Lymphknotenmetastasen bei kolorektalen Karzinomen

Gomille, T.; Aleksic, M.; Ulrich, B.; Christ, F

doi:10.1007/s001170050465

Cited by 13 publications

(7 citation statements)

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“…Conventionally, a LAD of > 10 mm has been accepted as a potential sign of LN metastases [5, 6]. Reported sensitivities and specificities of LN size and/or clusters of ≥ 3 LNs were 56–84.3% and 58–95%, respectively [5–9].…”

Section: Discussionmentioning

confidence: 99%

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Optimal diagnostic method using multidetector-row computed tomography for predicting lymph node metastasis in colorectal cancer

et al. 2019

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Background Prediction of nodal involvement in colorectal cancer is an important aspect of preoperative workup to determine the necessity of preoperative treatment and the adequate extent of lymphadenectomy during surgery. This study aimed to investigate newer multidetector-row computed tomography (MDCT) findings for better predicting lymph node (LN) metastasis in colorectal cancer. Methods Seventy patients were enrolled in this study; all underwent MDCT prior to surgery and upfront curative resection for colorectal cancer. LNs with a short-axis diameter (SAD) ≥ 4 mm were identified on MDCT images, and the following measures were recorded by two radiologists independently: two-dimensional (2D) SAD, 2D long-axis diameter (LAD), 2D ratio of SAD to LAD, 2D CT attenuation value, three-dimensional (3D) SAD, 3D LAD, 3D SAD to LAD ratio, 3D CT attenuation value, LN volume, and presence of extranodal neoplastic spread (ENS), as defined by indistinct nodal margin, irregular capsular enhancement, or infiltration into adjacent structures. Results Forty-six patients presented 173 LNs with a SAD ≥ 4 mm, while 24 patients exhibited pathologically confirmed LN metastases. Receiver operating characteristic analysis revealed that 2D LAD was the most sensitive measure for LN metastases with an area under the curve of 0.752 (cut-off value, 7.05 mm). When combined with CT findings indicating ENS, 2D LAD (> or ≤ 7 mm) showed enhanced predictive power for LN metastases (area under the curve, 0.846; p < 0.001). Conclusions LAD in axial MDCT imaging is the most sensitive measure for predicting colorectal LN metastases, especially when MDCT findings of ENS are observed.

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Section: Discussionmentioning

confidence: 99%

“…The LNs measuring > 10 mm in computed tomography (CT) images have conventionally been regarded as a sign of nodal involvement of cancer [5, 6]. Previous studies have reported the diagnostic accuracy of such CT measures, using axial images [5–9].…”

Section: Introductionmentioning

confidence: 99%

Optimal diagnostic method using multidetector-row computed tomography for predicting lymph node metastasis in colorectal cancer

et al. 2019

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“…These factors are accepted as predictors of lymph node involvement in colorectal cancer (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Therefore, we should conduct further analyses with a larger number of patients.…”

Section: Discussionmentioning

confidence: 99%

“…In previous findings, it was reported that lymph nodes with a diameter larger than 1 cm, three or more clustered lymph nodes regardless of their size, and irregular surface, were predictive factors for lymph node involvement (sensitivity: 66-96.3% and specificity: 35-81%) (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). On the other hand, thus far, there has only been a single report stating the lymph node involvement of rectal NETs predicted by CT (19), and there have been no reports concerning colorectal NETs.…”

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confidence: 89%

Expand+In Vivoiv.iiarjournals.orgIn Vivo September-October 2017 vol. 31 no. 5 1011-1017 Lymph Node Size on Computed Tomography Images Is a Predictive Indicator for Lymph Node Metastasis in Patients with Colorectal Neuroendocrine Tumors

Tanaka

Nozawa

Kawai

et al. 2018

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Neuroendocrine tumors (NET) are a rare malignancy arising from amine precursor uptake and decarboxylation of cells (1). According to WHO classification released in 2010, they are categorized into three groups according to their pathological features (2). The incidence of NETs in each organ is unclear. However, a population-based study revealed that the gastrointestinal tract is the most common site (54.5%) of NET G1, which is the major NET subtype. Moreover, within the gastrointestinal tract, colon and rectum (36.3%) are the second most common gastrointestinal sites following the small intestine (3). The survival of a patient with NET differs among each pathological grade. Patients with colorectal NET G1 have the most beneficial 5-year survival from 92.1% to 100% (2, 4), followed by those with NET G2. Even patients with neuroendocrine carcinoma (NET G3), the most aggressive subtype of NET, have a postoperative 5-year survival of 26.3-57.4% when distant metastasis is absent (5). Thus, we consider that a radical resection along with an appropriate regional lymphadenectomy is necessary for NET. The indication of lymphadenectomy is commonly determined by the tumor size, the depth of the tumor, lympho-vascular invasion, along with lymph node metastasis proven by the clinical images (6, 7).The manifestation of lymph node metastasis observed via clinical images is routinely performed by contrast-enhanced computed tomography (CT) in colorectal cancer. In previous findings, it was reported that lymph nodes with a diameter larger than 1 cm, three or more clustered lymph nodes regardless of their size, and irregular surface, were predictive factors for lymph node involvement (sensitivity: 66-96.3% and specificity: 35-81%) (8-18). On the other hand, thus far, there has only been a single report stating the lymph node 1011

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“…zum präoperativen Staging eines kolorektalen Karzinoms eingesetzt werden[47]. In der CT kann zwar nicht zwischen T1-und T2-Stadium des Tumors unterschieden werden[48], dies ist allerdings für die Therapieentscheidung nicht wichtig[49]. In einem Vergleich mit Endosonographie, MRT und Endo-MRT (mit endoanaler Spule) schneidet die CT hinsichtlich Sensitivität und Spezifität in der Beurteilung des T-Stadiums eines Rektumkarzinoms schlechter ab[38].…”

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Häufigste Differenzialdiagnosen des analen Blutabgangs▬ Analkanal -Hämorrhoiden -Tumor -Fissur -Analprolaps -Trauma ▼ 3.1 • Anamnese c ⊡ Abb. 3-1a-c. Proktologische Untersuchungspositionen. a Knie-Ellbogen-Position, b Linksseitenposition, c Steinschnittposition a b ⊡ Abb. 3-5a-c. Rektaluntersuchung. Abtastung von Analkanal und Rektummukosa durch eine 360°-Bewegung des Fingers a c b ⊡ Abb. 3-6. Instrumente und Zubehör zur Anoproktoskopie und Rektoskopie ⊡ Abb. 3-7a-c. Proktoskopie. a Platzierung des Proktoskops auf den Anus. Das Instrument wird angelegt, der Patient wird aufgefordert zu pressen. b, c Das Instrument wird eingeführt a c b 3.3 • Endoskopie ⊡ Abb. 3-8. Analkanalmukosa: normale, glatt-glänzende Mukosa ⊡ Abb. 3-9a, b. Rektoskopie. a Einführung des Instruments mit eingesetztem Mandrin, b entfernter Mandrin, aufgesetztes Okularfenster, Lichtleiterkabel und Insufflationsvorrichtung a b

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Bedeutung der CT für die Beurteilung regionärer Lymphknotenmetastasen bei kolorektalen Karzinomen

Cited by 13 publications

References 11 publications

Optimal diagnostic method using multidetector-row computed tomography for predicting lymph node metastasis in colorectal cancer

Optimal diagnostic method using multidetector-row computed tomography for predicting lymph node metastasis in colorectal cancer

Expand+In Vivoiv.iiarjournals.orgIn Vivo September-October 2017 vol. 31 no. 5 1011-1017 Lymph Node Size on Computed Tomography Images Is a Predictive Indicator for Lymph Node Metastasis in Patients with Colorectal Neuroendocrine Tumors

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