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Preoperative Diagnosis of Lymph Node Metastasis in Biliary and Pancreatic Carcinomas: Evaluation of the Combination of Multi-detector CT and Serum CA19-9 Level

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Abstract

Background

It is difficult to diagnose lymph node metastasis in biliary and pancreas carcinomas before surgery.

Aim

The aim of this study was to assess the utility of the combination of multi-detector computed tomographic (MDCT) findings and serum carbohydrate antigen (CA)19-9 level in the diagnosis of lymph node metastasis in biliary and pancreas carcinomas.

Methods

The subjects were 139 patients with biliary and pancreas carcinomas who underwent surgical resection. We calculated the positive predictive values (PPV), sensitivities, specificities, positive likelihood ratios (PLR) and accuracies of diagnosis by MDCT alone, serum CA19-9 level alone, and their combination.

Results

The PPV and sensitivity were higher for node metastasis in hepatoduodenal ligament than in common hepatic artery (CHA) or para-aortic region (PAR). Specificity, accuracy and PLR were highest for CHA in biliary carcinoma. With pancreatic carcinoma, PLR was slightly higher in PAR compared to other regions. The sensitivity of CA19-9 for node metastasis was higher than that of MDCT, while the PPV, specificity, accuracy and PLR were low for both biliary and pancreas carcinoma. The combination of positive CT findings and high CA19-9 level had the highest positive rate for node metastasis for both types of carcinomas. Nodes around the supra-mesenteric vein could not be fully observed on CT.

Conclusion

The combination of high-resolution MDCT and CA19-9 is useful for the diagnosis of lymph node metastasis in biliary and pancreas carcinomas.

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Acknowledgment

This study was undertaken without any financial support.

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Authors and Affiliations

  1. Division of Surgical Oncology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Atsushi Nanashima, Syuuichi Tobinaga, Masato Araki, Masaki Kunizaki, Takashi Nonaka, Hiroaki Takeshita, Shigekazu Hidaka, Terumitsu Sawai, Toru Yasutake & Takeshi Nagayasu

  2. Department of Radiology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Ichiro Sakamoto

  3. Department of Pathology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Tomayoshi Hayashi

  4. Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Atsushi Nanashima

Authors
  1. Atsushi Nanashima
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  2. Ichiro Sakamoto
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  3. Tomayoshi Hayashi
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  4. Syuuichi Tobinaga
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  5. Masato Araki
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  6. Masaki Kunizaki
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  7. Takashi Nonaka
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  9. Shigekazu Hidaka
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  10. Terumitsu Sawai
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  11. Toru Yasutake
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  12. Takeshi Nagayasu
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Correspondence to Atsushi Nanashima.

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Nanashima, A., Sakamoto, I., Hayashi, T. et al. Preoperative Diagnosis of Lymph Node Metastasis in Biliary and Pancreatic Carcinomas: Evaluation of the Combination of Multi-detector CT and Serum CA19-9 Level. Dig Dis Sci 55, 3617–3626 (2010). https://doi.org/10.1007/s10620-010-1180-y

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  • DOI: https://doi.org/10.1007/s10620-010-1180-y

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