Establishment of a multi-parameters MRI model for predicting small lymph nodes metastases (<10 mm) in patients with resected pancreatic ductal adenocarcinoma

Abstract

Purpose To evaluate the potential role of MR findings and DWI parameters in predicting small regional lymph nodes metastases (with short-axis diameter &lt; 10 mm) in pancreatic ductal adenocarcinomas (PDACs). Methods A total of 127 patients, 82 in training group and 45 in testing group, with histopathologically diagnosed PDACs who underwent pancreatectomy were retrospectively analyzed. PDACs were divided into two groups of positive and negative lymph node metastases (LNM) based on the pathological results. Pancreatic cancer characteristics, short axis of largest lymph node, and DWI parameters of PDACs were evaluated. Results Univariate and multivariate analyses showed that extrapancreatic distance of tumor invasion, short-axis diameter of the largest lymph node, and mean diffusivity of tumor were independently associated with small LNM in patients with PDACs. The combining MRI diagnostic model yielded AUCs of 0.836 and 0.873, and accuracies of 81.7% and 80% in the training and testing groups. The AUC of the MRI model for predicting LNM was higher than that of subjective MRI diagnosis in the training group (rater 1, P = 0.01; rater 2, 0.008) and in a testing group (rater 1, P = 0.036; rater 2, 0.024). Comparing the subjective diagnosis, the error rate of the MRI model was decreased. The defined LNM-positive group by the MRI model showed significantly inferior overall survival compared to the negative group (P = 0.006). Conclusions The MRI model showed excellent performance for individualized and noninvasive prediction of small regional LNM in PDACs. It may be used to identify PDACs with small LNM and contribute to determining an appropriate treatment strategy for PDACs.

Prediction of hepatic lymph node metastases based on magnetic resonance imaging before and after preoperative chemotherapy in patients with colorectal liver metastases underwent surgical resection

“…Hida et al [ 14 ] analyzed the lateral lymph node status of rectal cancer on MR images in 322 patients, finding short diameter ≥ 5 mm could well differentiate metastatic and negative lymph nodes, with a significant difference in survival between the two groups. Moreover, Shi et al [ 28 ] explored the clinicopathological and radiological features of 127 resected pancreatic ductal adenocarcinoma and determined that the short diameter of the largest lymph node was an independent predictor for lymph node status (OR, 1.528; P = 0.011). It should be noted that many other parameters, such as short/ long diameter ratio, and lymph node number, are also considered to reflect metastatic burden and prognosis in previous studies [ 29 , 30 ].…”

Analysis of Risk Factors for Distant Metastasis of Pancreatic Ductal Adenocarcinoma without Regional Lymph Node Metastasis and a Nomogram Prediction Model for Survival

“…Patients with regional lymph node metastasis are more likely to have distant metastasis, and their prognosis is significantly worse than that of patients with negative regional lymph nodes ( N 0) [ 10 ]. PDAC patients with regional lymph node metastasis often require more treatment and closer monitoring [ 11 ]. N 0 is considered a good prognostic indicator.…”