Abstract
BackgroundLymph node staging of ductal adenocarcinoma of the pancreatic head (PDAC) by cross-sectional imaging is limited. The aim of this study was to determine the diagnostic accuracy of expanded criteria in nodal staging in PDAC patients.MethodsSixty-six patients with histologically confirmed PDAC that underwent primary surgery were included in this retrospective IRB-approved study. Cross-sectional imaging studies (CT and/or MRI) were evaluated by a radiologist blinded to histopathology. Number and size of lymph nodes were measured (short-axis diameter) and characterized in terms of expanded morphological criteria of border contour (spiculated, lobulated, and indistinct) and texture (homogeneous or inhomogeneous). Sensitivities and specificities were calculated with histopathology as a reference standard.ResultsForty-eight of 66 patients (80%) had histologically confirmed lymph node metastases (pN+). Sensitivity, specificity, and Youden’s Index for the criterion “size” were 44.2%, 82.4%, and 0.27; for “inhomogeneous signal intensity” 25.6%, 94.1%, and 0.20; and for “border contour” 62.7%, 52.9%, and 0.16, respectively. There was a significant association between the number of visible lymph nodes on preoperative CT and lymph node involvement (pN+, p = 0.031).ConclusionLymph node staging in PDAC is mainly limited due to low sensitivity for detection of metastatic disease. Using expanded morphological criteria instead of size did not improve regional nodal staging due to sensitivity remaining low. Combining specific criteria yields improved sensitivity with specificity and PPV remaining high.
Highlights
Lymph node staging of ductal adenocarcinoma of the pancreatic head (PDAC) by cross-sectional imaging is limited
Sixty of these patients were staged by preoperative computed tomography (CT), twelve of which had additional staging by Magnetic resonance imaging (MRI), and six patients were staged by only MRI
Eight of them were staged by CT only and two by MRI only
Summary
Lymph node staging of ductal adenocarcinoma of the pancreatic head (PDAC) by cross-sectional imaging is limited. Apart from the potential to increase the resectability rate of pancreatic cancer by neoadjuvant therapy [6, 7], there is evidence that patients which are successfully downstaged from node-positive disease (cN1) to nodenegative disease (ypN0) prior to surgery benefit in terms of higher 5-year survival rate [8]. This would qualify nodal involvement as a sufficient basis for indicating neoadjuvant therapy. The indication of a potentially effective neoadjuvant therapy (cN+) with side effects in lymph node-positive patients (cN+) is mainly based on unreliable clinical staging
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