Abstract

BackgroundAccurate evaluation of lymph node metastasis in bladder cancer (BCa) is important for disease staging, treatment selection, and prognosis prediction. In this study, we aimed to evaluate the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) for metastatic lymph nodes in BCa and establish criteria of imaging diagnosis.MethodsWe retrospectively assessed the imaging characteristics of 191 BCa patients who underwent radical cystectomy. The data regarding size, shape, density, and diffusion of the lymph nodes on CT and/or MRI were obtained and analyzed using Kruskal–Wallis test and χ2 test. The optimal cutoff value for the size of metastatic node was determined using the receiver operating characteristic (ROC) curve analysis.ResultsA total of 184 out of 3317 resected lymph nodes were diagnosed as metastatic lymph nodes. Among 82 imaging-detectable lymph nodes, 51 were confirmed to be positive for metastasis. The detection rate of metastatic nodes increased along with more advanced tumor stage (P < 0.001). Once the ratio of short- to long-axis diameter ≤ 0.4 or fatty hilum was observed in lymph nodes on imaging, it indicated non-metastases. Besides, lymph nodes with spiculate or obscure margin or necrosis indicated metastases. Furthermore, the short diameter of 6.8 mm was the optimal threshold to diagnose metastatic lymph node, with the area under ROC curve of 0.815.ConclusionsThe probability of metastatic nodes significantly increased with more advanced T stages. Once lymph nodes are detected on imaging, the characteristic signs should be paid attention to. The short diameter > 6.8 mm may indicate metastatic lymph nodes in BCa.

Highlights

  • Accurate evaluation of lymph node metastasis in bladder cancer (BCa) is important for disease staging, treatment selection, and prognosis prediction

  • The following patients were excluded: (1) 4 patients who underwent neoadjuvant chemotherapy; (2) 32 who underwent laparoscopic radical cystectomy but without standard pelvic lymphadenectomy; (3) 44 with imaging performed at other hospitals; (4) 3 with imaging performed more than 10 days before surgery; and (5) 2 with magnetic resonance imaging (MRI) artifacts

  • (20.4%) excluded due to: 44 with imaging performed at other hospitals 3 with imaging performed more than 10 days before surgery 2 had arƟfacts on MRI

Read more

Summary

Introduction

Accurate evaluation of lymph node metastasis in bladder cancer (BCa) is important for disease staging, treatment selection, and prognosis prediction. We aimed to evaluate the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) for metastatic lymph nodes in BCa and establish criteria of imaging diagnosis. Computed tomography (CT) and magnetic resonance imaging (MRI) have long been used to detect lymph node metastases in patients with BCa before operation. The accuracy of DW MRI in detecting lymph node metastases is still being contested [7]. USPIO-enhanced MRI has already shown promising results for the detection of metastases in normal-sized lymph nodes, the limited commercial availability and occasional adverse events restricted its application [8]. The optimal imaging method for detecting metastasis in lymph nodes, especially normal-sized lymph nodes, before surgery is lacking

Objectives
Methods
Results
Discussion
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call