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

Abstract

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.

Clinical analysis of metastatic characteristics of infrapyloric lymph nodes (No.206) and terminal ileum lymph nodes in patients with right colon cancer

“…Long-term survival after colorectal cancer may be improved by more extensive resection of the primary tumor and lymph nodes [ 19 , 20 ] Resection of the gastroepiploic and infrapyloric lymph nodes in the gastrocolic ligament has been proposed as a standard procedure when resecting tumors located in the proximity of the flexures or in the transverse colon [ 21 ]. In addition to the central direction, the lymph node drainage of the right colon cancer may also cause the subpyloric drainage [ 22 ].…”

A Pilot Study of Prognostic Value of Metastatic Lymph Node Count and Size in Patients with Different Stages of Gastric Carcinoma

“…As a result, MDCT detected significantly fewer metastatic LNs than histologic examination, which may lead to an underestimation of N staging. 13 , 14 …”

Predictive value of computed tomography with coronal reconstruction in right hemicolectomy with complete mesocolic excision for right colon cancers: a retrospective study

“…Therefore, methods for predicting the critical anatomical sites of colon cancer before the operation have become an area of interest for surgeons [ 14 , 15 ]. Surgeons and radiologists have tried to predict vascular anatomical variations with multidetector computed tomography (MDCT) angiography and three-dimensional CT (3D-CT), which have been reported to have high sensitivity, specificity, accuracy and reliability [ 16 , 17 ].…”