Prediction of Lateral Pelvic Lymph-Node Metastasis in Low Rectal Cancer by Magnetic Resonance Imaging
Prediction of Lateral Pelvic Lymph-Node Metastasis in Low Rectal Cancer by Magnetic Resonance Imaging
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DOI：
10.1007/s00268-015-3299-7
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发表时间：
2016-04-01
影响因子：
2.6
通讯作者：
Endo, Itaru
中科院分区：
文献类型：
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作者：
Ishibe, Atsushi;Ota, Mitsuyoshi;Endo, Itaru
为评价磁共振成像(MRI)对低位直肠癌盆腔外侧淋巴结转移的诊断准确性，对84例低位直肠癌患者进行了MRI检查，并在术前未作处理的情况下，行盆腔外侧淋巴结清扫根治术。术前行MRI检查侧方淋巴结转移，并与病理结果对照。盆腔侧方淋巴结转移的标准是盆壁内任何可识别的淋巴结，无论其直径大小。16例患者(19.9%)术前MRI诊断为盆腔侧方淋巴结转移。MRI的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为75%、69.1%、36.4%、92.2%和70.2%。以10 mm为诊断临界值时，对应值分别为43.8、98.5、87.5、88.1和88.1%。转移结节的平均直径(14.7 mm)明显大于阴性结节(5.7 mm；P<；0.01)。MRI是预测盆腔外侧结节侵犯的有效方法，有助于直肠癌的术前决策。10 mm的分界值有助于避免不必要的侧方淋巴结清扫。
This study was designed to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) for lateral pelvic lymph-node metastasis.Eighty-four patients with primary lower rectal cancer were examined by MRI and subsequently underwent radical surgery with lateral pelvic lymph-node dissection, without preoperative treatment. Lateral lymph-node metastases were assessed preoperatively by MRI, and the results were compared with the histopathological findings. The criterion for lateral lymph-node metastasis was any recognizable lymph node in the pelvic wall, regardless of diameter.Lateral pelvic lymph-node metastasis was diagnosed on preoperative MRI in 16 patients (19.9 %). The overall patient-based sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI were 75, 69.1, 36.4, 92.2, and 70.2 %, respectively. When a cut-off value of 10 mm was used for diagnosis, the corresponding values were 43.8, 98.5, 87.5, 88.1, and 88.1 %, respectively. The mean diameter of metastatic nodes (14.7 mm) was significantly larger than that of negative nodes (5.7 mm; P < 0.01).MRI is an effective technique for predicting lateral pelvic node involvement and thus may facilitate preoperative decision-making in rectal cancer treatment. A cut-off value of 10 mm is useful for avoiding unnecessary lateral lymph-node dissection.