Jianfang Liu1,2, Zhu Wang3, Huafei Shao4, Dong Qu1, Jian Liu5, Libo Yao1. 1. National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China. 2. Capital Medical University Electric Power Teaching Hospital, Beijing, 100027, China. 3. National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China. wangzhu@cicams.ac.cn. 4. Affiliated Yantai Yuhuangding Hospital of Qingdao University Medical College, Yantai, 264000, China. 5. Meitan General Hospital, Beijing, 100028, China.
Abstract
OBJECTIVES: To investigate the value of CT with inclusion of smaller lymph node (LN) sizes and axial ratio to improve the sensitivity in diagnosis of regional lymph node metastases in oesophageal squamous cell carcinoma (OSCC). METHODS: The contrast-enhanced multidetector row spiral CT (MDCT) multiplanar reconstruction images of 204 patients with OSCC were retrospectively analysed. The long-axis and short-axis diameters of the regional LNs were measured and axial ratios were calculated (short-axis/long-axis diameters). Nodes were considered round if the axial ratio exceeded the optimal LN axial ratio, which was determined by receiver operating characteristic analysis. RESULTS: A positive predictive value (PPV) exceeding 50% is needed. This was achieved only with LNs larger than 9 mm in short-axis diameter, but nodes of this size were rare (sensitivity 37.3%, specificity 96.4%, accuracy 85.8%). If those round nodes (axial ratio exceeding 0.66 ) between 7 mm and 9 mm in size were considered metastases as well, it might improve the sensitivity to 67.2% with a PPV of 63.9% (specificity 91.6%, accuracy 87.2%). CONCLUSION: Combination of a smaller size and axial ratio for LNs in MDCT as criteria improves the detection sensitivity for LN metastases in OSCC. KEY POINTS: • CT is widely used to assess metastatic lymph nodes. • CT has low sensitivity in detecting metastases using conventional criteria. • Diagnostic sensitivity of CT was improved by using lymph node axial ratio. • New diagnostic criteria provide greater diagnostic confidence with PPVs exceeding 50%. • New diagnostic criteria may help clinicians assess patients with oesophageal cancer.
OBJECTIVES: To investigate the value of CT with inclusion of smaller lymph node (LN) sizes and axial ratio to improve the sensitivity in diagnosis of regional lymph node metastases in oesophageal squamous cell carcinoma (OSCC). METHODS: The contrast-enhanced multidetector row spiral CT (MDCT) multiplanar reconstruction images of 204 patients with OSCC were retrospectively analysed. The long-axis and short-axis diameters of the regional LNs were measured and axial ratios were calculated (short-axis/long-axis diameters). Nodes were considered round if the axial ratio exceeded the optimal LN axial ratio, which was determined by receiver operating characteristic analysis. RESULTS: A positive predictive value (PPV) exceeding 50% is needed. This was achieved only with LNs larger than 9 mm in short-axis diameter, but nodes of this size were rare (sensitivity 37.3%, specificity 96.4%, accuracy 85.8%). If those round nodes (axial ratio exceeding 0.66 ) between 7 mm and 9 mm in size were considered metastases as well, it might improve the sensitivity to 67.2% with a PPV of 63.9% (specificity 91.6%, accuracy 87.2%). CONCLUSION: Combination of a smaller size and axial ratio for LNs in MDCT as criteria improves the detection sensitivity for LN metastases in OSCC. KEY POINTS: • CT is widely used to assess metastatic lymph nodes. • CT has low sensitivity in detecting metastases using conventional criteria. • Diagnostic sensitivity of CT was improved by using lymph node axial ratio. • New diagnostic criteria provide greater diagnostic confidence with PPVs exceeding 50%. • New diagnostic criteria may help clinicians assess patients with oesophageal cancer.
Authors: K L Prenzel; A H Hölscher; D Vallböhmer; U Drebber; C A Gutschow; S P Mönig; D L Stippel Journal: Eur J Surg Oncol Date: 2010-07-01 Impact factor: 4.424
Authors: K Kawahara; T Maekawa; K Okabayashi; T Shiraishi; Y Yoshinaga; S Yoneda; T Hideshima; T Shirakusa Journal: J Surg Oncol Date: 1998-03 Impact factor: 3.454