Accuracy of various criteria for lymph node staging in ductal adenocarcinoma of the pancreatic head by computed tomography and magnetic resonance imaging

• Published in: World journal of surgical oncology Vol. 18; no. 1; pp. 213 - 10
• Main Authors: Loch, Florian N., Asbach, Patrick, Haas, Matthias, Seeliger, Hendrik, Beyer, Katharina, Schineis, Christian, Degro, Claudius E., Margonis, Georgios A., Kreis, Martin E., Kamphues, Carsten
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 18.08.2020; BioMed Central; BMC
• Subjects: Abdomen; Accuracy; Adenocarcinoma; Breast Neoplasms; Cancer; Care and treatment; Computed tomography; Contours; Criteria; Cross-sectional imaging; Diagnosis; Diagnostic imaging; Diagnostic systems; Diameters; Ductal adenocarcinoma of the pancreatic head; Histopathology; Humans; Lymph nodes; Lymph Nodes - diagnostic imaging; Lymph Nodes - surgery; Lymphatic system; Lymphatics; Magnetic Resonance Imaging; Medical examination; Medical imaging; Metastases; Metastasis; Morphology; Neoplasm Staging; Oncology, Experimental; Pancreas; Pancreatic cancer; Patients; Prognosis; Quality; Retrospective Studies; Sensitivity; Sensitivity and Specificity; Shape; Staging; Surgery; Tomography, X-Ray Computed; Tumors; Germany; Neoadjuvant therapy; Cross-sectional imaging; Computed tomography; Magnetic resonance imaging; Staging; Lymph nodes; Ductal adenocarcinoma of the pancreatic head
• ISSN: 1477-7819; 1477-7819
• DOI: 10.1186/s12957-020-01951-3

Lymph 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. Sixty-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. Forty-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). Lymph 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.