Perihepatic lymph node assessment in patients undergoing partial hepatectomy for malignancy
Perihepatic lymph node assessment in patients undergoing partial hepatectomy for malignancy
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DOI：
10.1097/01.sla.0000217606.59625.9d
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发表时间：
2006-08-01
影响因子：
9
通讯作者：
Jarnagin, William R.
中科院分区：
文献类型：
--
作者：
Grobmyer, Stephen R.;Wang, Liang;Jarnagin, William R.
目的：探讨恶性肿瘤肝部分切除术患者术前影像检查和术中肝周淋巴结评估的价值。摘要背景资料：肝周淋巴结状况是影响肝切除1度和转移性肿瘤预后的重要因素。术前影像检查和术中评估肝周淋巴结的价值尚不清楚。方法：对100例P级和转移性肝肿瘤切除患者的肝周淋巴结进行采样。在抽样时，参与的外科医生给出了临床怀疑评分(1-5：1=临床阴性，5=临床阳性)。术前CT扫描和PET扫描由2名放射科医生进行盲法检查。根据淋巴结的病理状态对临床评估、CT和PET扫描结果进行分析。结果：平均每个患者抽取3.2+/-0.2个淋巴结。15例有肝周淋巴结转移，13例术前CT或PET提示，2例探查时临床阳性。临床评估的阴性预测值(NPV)为99%，阳性预测值(PPV)为39%。同样，CT扫描具有高NPV=95%和低PPV=30%。PET扫描的NPV=88%，PPV为100%。在48例术前CT和PET扫描均为阴性的患者中，只有1例(2.1%)有转移性结节病变，这是根据临床评估而怀疑的。在CT和PET检查阴性、临床评估阴性的39例患者中，无一例累及肝周淋巴结。结论：在1度及转移性肝癌患者中，真正隐匿性的肝周淋巴结转移率较低。因此，在术前CT或PET扫描或探查时没有任何疾病证据的患者中，常规的肝周淋巴结采样的得率很低。
Objective: To assess the value of preoperative imaging studies and the intraoperative assessment of perihepatic lymph nodes in patients undergoing partial hepatectomy for malignancy.Summary Background Data: Perihepatic lymph node status is an important prognostic factor for patients undergoing hepatic resection for 1 degrees and metastatic cancer. The value of preoperative imaging studies and intraoperative assessment of perihepatic nodes is unknown.Methods: Perihepatic lymph nodes were sampled in 100 patients undergoing resection for P and metastatic hepatic malignancy. At the time of sampling, participating surgeons assigned a clinical suspicion score (scale, 1-5: 1 = clinically negative, 5 = clinically positive). Preoperative CT scans and PET scans were reviewed in a blinded fashion by 2 radiologists. Clinical assessment, CT, and PET scan results were analyzed in the context of the pathologic status of the lymph nodes.Results: A mean of 3.2 +/- 0.2 nodes were sampled per patient. Fifteen patients had metastatic disease in perihepatic lymph nodes; 13 had suggestive findings on preoperative CT or PET, and 2 were clinically positive at exploration. Clinical assessment had a high negative predictive value (NPV) = 99% but a low positive predictive value (PPV) = 39%. Similarly, CT scans had a high NPV = 95% and a low PPV = 30%. PET scans had a NPV = 88% and a PPV of 100%. Of the 48 patients with both negative preoperative CT and PET scans, only 1 (2.1%) had metastatic nodal disease, and this was suspected based on the clinical assessment. Of the patients with negative CT and PET scans and a negative clinical assessment (n = 39), none had involved perihepatic nodes.Conclusions: In patients with 1 degrees and metastatic liver cancer, the incidence of truly occult metastatic disease to perihepatic lymph nodes is low. Routine sampling of perihepatic lymph nodes will therefore have a low yield in patients without some evidence of disease on preoperative CT or PET scans or at the time of exploration.