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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References
Baton O, Azoulay D, Adam DV, Castaing D. Major hepatectomy for hilar cholangiocarcinoma type 3 and 4: prognostic factors and long term outcomes. J Am Coll Surg. 2007;204:250–260.
Zacharias T, Jaeck D, Oussoultzoglou E, Neuville A, Bachellier P. Impact of lymph node involvement on long-term survival after R0 pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas. J Gastrointest Surg. 2007;11:350–356.
Noji T, Kondo S, Hirano S, Tanaka E, Suzuki O, Shichinohe T. Computed tomography evaluation of regional lymph node metastases in patients with biliary cancer. Br J Surg. 2008;95:92–96.
Unno M, Okumoto T, Katayose Y, et al. Preoperative assessment of hilar cholangiocarcinoma by multidetector row computed tomography. J Hepatobiliary Pancreat Surg. 2007;14:434–440.
Ishigami K, Yoshimitsu K, Irie H, et al. Significance of perivascular soft tissue around the common hepatic and proximal superior mesenteric arteries arising after pancreaticoduodenectomy: evaluation with serial MDCT studies. Abdom Imaging. 2008;33:654–661.
Kim YC, Park MS, Cha SW, et al. Comparison of CT and MRI for presurgical characterization of paraaortic lymph nodes in patients with pancreatico-biliary carcinoma. World J Gastroenterol. 2008;14:2208–2212.
Schwartz LH, Black J, Fong Y, et al. Gallbladder carcinoma: findings at MR imaging with MR cholangiopancreatography. J Comput Assist Tomogr. 2002;26:405–410.
Furukawa H, Ikuma H, Asakura-Yokoe K, Uesaka K. Preoperative staging of biliary carcinoma using 18F-fluorodeoxyglucose PET: prospective comparison with PET + CT, MDCT and histopathology. Eur Radiol. 2008;18:2841–2847.
Brockmann J, Emparan C, Hernandez CA, et al. Gallbladder bile tumor marker quantification for detection of pancreato-biliary malignancies. Anticancer Res. 2000;20:4941–4947.
Hayakawa T, Naruse S, Kitagawa M, et al. A prospective multicenter trial evaluating diagnostic validity of multivariate analysis and individual serum marker in differential diagnosis of pancreatic cancer from benign pancreatic diseases. Int J Pancreatol. 1999;25:23–29.
Japanese Society of Biliary Surgery. Extrahepatic bile duct, gallbladder, papillary of vater, histology. In: Nagakawa T, ed. Classification of biliary tract carcinoma. Second English Edition. Tokyo: Kanehara; 2004:12–78.
Japan Pancreas Society. Description of findings, surgical treatment. In: Kawarada Y, ed. Classification of pancreatic carcinoma. Second English Edition. Tokyo: Kanehara; 2003:4–17.
Kondo S, Nimura Y, Hayakawa N, Kamiya J, Nagino M, Uesaka K. Regional and para-aortic lymphadenectomy in radical surgery for advanced gallbladder carcinoma. Br J Surg. 2000;87:418–422.
Noji T, Kondo S, Hirano S, et al. CT evaluation of paraaortic lymph node metastasis in patients with biliary cancer. J Gastroenterol. 2005;40:739–743.
Watadani T, Akahane M, Yoshikawa T, Ohtomo K. Preoperative assessment of hilar cholangiocarcinoma using multidetector-row CT: correlation with histopathological findings. Radiat Med. 2008;26:402–407.
Prenzel KL, Mönig SP, Sinning JM, et al. Lymph node size and metastatic infiltration in non-small cell lung cancer. Chest. 2003;123:463–467.
Mönig SP, Zirbes TK, Schröder W, et al. Staging of gastric cancer: correlation of lymph node size and metastatic infiltration. AJR Am J Roentgenol. 1999;173:365–367.
Ohtani T, Shirai Y, Tsukada K, Muto T, Hatakeyama K. Spread of gallbladder carcinoma: CT evaluation with pathologic correlation. Abdom Imaging. 1996;21:195–201.
Kayahara M, Nagakawa T, Ohta T, et al. Analysis of paraaortic lymph node involvement in pancreatic carcinoma: a significant indication for surgery? Cancer. 1999;85:583–590.
Bley TA, Uhl M, Simon P, et al. Diagnostic accuracy of MRI for preoperative staging of pancreatic carcinoma: tendency for understaging. In Vivo. 2005;19:983–987.
Agarwal B, Gogia S, Eloubeidi MA, Correa AM, Ho L, Collins BT. Malignant mediastinal lymphadenopathy detected by staging EUS in patients with pancreaticobiliary cancer. Gastrointest Endosc. 2005;61:849–853.
Naini BV, Apple SK, Presley M, Moatamed NA. A correlation study on diagnostic endoscopic ultrasound-guided fine-needle aspiration of lymph nodes with histological and clinical diagnoses, the UCLA Medical Center experience. Diagn Cytopathol. 2008;36:460–466.
Torok N, Gores GJ. Cholangiocarcinoma. Semin Gastrointest Dis. 2001;12:125–132.
Hess V, Glimelius B, Grawe P, et al. CA 19–9 tumour-marker response to chemotherapy in patients with advanced pancreatic cancer enrolled in a randomised controlled trial. Lancet Oncol. 2008;9:132–138.
Waraya M, Yamashita K, Katagiri H, et al. Preoperative serum CA19–9 and dissected peripancreatic tissue margin as determiners of long-term survival in pancreatic cancer. Ann Surg Oncol. 2009;16:1231–1240.
Marrelli D, Caruso S, Pedrazzani C, et al. CA19–9 serum levels in obstructive jaundice: clinical value in benign and malignant conditions. Am J Surg. 2009;198:333–339.
Chen CY, Shiesh SC, Tsao HC, Lin XZ. The assessment of biliary CA 125, CA 19-9 and CEA in diagnosing cholangiocarcinoma—the influence of sampling time and hepatolithiasis. Hepatogastroenterology. 2002;49:616–620.
Duraker N, Hot S, Polat Y, Höbek A, Gençler N, Urhan N. CEA, CA 19-9, and CA 125 in the differential diagnosis of benign and malignant pancreatic diseases with or without jaundice. J Surg Oncol. 2007;95:142–147.
Alvaro D. Serum and bile biomarkers for cholangiocarcinoma. Curr Opin Gastroenterol. 2009;25:279–284.
Kokudo N, Makuuchi M, Natori T, et al. Strategies for surgical treatment of gallbladder carcinoma based on information available before resection. Arch Surg. 2003;138:741–750.
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This study was undertaken without any financial support.
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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