The Role of CT in Assessment of Extraregional Lymph Node Involvement in Pancreatic and Periampullary Cancer: A Diagnostic Accuracy Study
Tseng, Dorine S J; Pranger, Bobby K; van Leeuwen, Maarten S; Pennings, Jan Pieter; Brosens, Lodewijk A; Mohammad, Nadja Haj; de Meijer, Vincent E; van Santvoort, Hjalmar C; Erdmann, Joris I; Molenaar, I Quintus
(2021) Radiology. Imaging cancer, volume 3, issue 2, pp. 1 - 8
(Article)
Abstract
Purpose: To investigate the diagnostic accuracy of CT in assessing extraregional lymph node metastases in pancreatic head and periampullary cancer. Materials and Methods: This prospective observational cohort study was performed at two tertiary hepatopancreatobiliary (HPB) referral centers between March 2013 and December 2014. Patients undergoing pancreatoduodenectomy or bypass surgery with
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or without palliative radiofrequency ablation were included. Extraregional lymph node involvement was defined as positive lymph nodes in the aortocaval window. Two expert HPB radiologists assessed aortocaval lymph nodes at preoperative CT according to a standardized protocol. All tissue from the aortocaval window was collected intraoperatively. Positive histopathologic finding was the reference standard. Analysis of predictive values and diagnostic accuracy was performed. Results: A total of 198 consecutive patients (mean age, 66 years; range, 39-86 years; 105 men) with pancreatic head or periampullary carcinoma were included. In 70% of patients, a pancreatoduodenectomy was performed, 4% underwent total pancreatectomy, 4% underwent radiofrequency ablation, and 22% underwent bypass surgery. Forty-four patients (22%) had histologically positive aortocaval lymph nodes. Negative predictive value of CT in assessing aortocaval lymph nodes was 80% for both observers, and positive predictive value was 31%-33%. Overall diagnostic accuracy was 69%-70%. Conclusion: CT has a low diagnostic accuracy in assessing extraregional lymph node metastases in patients suspected of having pancreatic or periampullary cancer.Keywords: CT, Abdomen/GI, Pancreas, Oncology© RSNA, 2021.
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Keywords: CT, Abdomen/GI, Pancreas, Oncology, Radiology Nuclear Medicine and imaging, Oncology, Journal Article
ISSN: 2638-616X
Publisher: Radiological Society of North America Inc.
Note: Funding Information: Department ofEpidemiology and Preventive Medicine, School of Veterinary Medicine. University ofCalifornia, Davis; Department of Virology. Southwest Foundation for Biomedical Research, San Antonio. Texas; California Regional Primate Research Center. Davis Funding Information: Received 23 December 1991; revised 25 August 1992. Presented in part: American Association for Laboratory Animal Science annual meeting. Anaheim. California. November 1992 (abstract STL-3). Monkeys were maintained in conditions compliant with standards ofthe National Institutes of Health (Guide for the Care and Use of Laboratory Animals. 1985. publication no. [NIH] 85-23). Grant support: National Institutes of Health (RR-05062. -03163. and -001669; -07038 to B.J.W.). Reprints or correspondence (present address): Dr. Benjamin J. Weigler, Dept. ofCompanion Animal and Special Species Medicine. College ofVeterinary Medicine. 4700 Hillsborough St., Raleigh. NC 27606. * Present affiliation: Department ofAnthropology. University ofCalifornia, Davis. Funding Information: Because of public health considerations and requirements for simian retrovirus research, the National Institutes of Health is funding efforts to establish B virus-free domestic breeding colonies ofrhesus monkeys [I I]. However, options Publisher Copyright: © RSNA, 2021.
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