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de Toledo-Mendes J, de Borborema CLP, Andreucci BK, Dias NG, Gomes MM, Purysko AS, Pacheco EO, Torres UDS, Mazzucato FL, D'Ippolito G. Mapping nodal metastasis in GI cancers: key lymphatic stations and dissemination patterns. Abdom Radiol (NY) 2025:10.1007/s00261-025-05001-y. [PMID: 40418373 DOI: 10.1007/s00261-025-05001-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2025] [Revised: 05/12/2025] [Accepted: 05/13/2025] [Indexed: 05/27/2025]
Abstract
Gastrointestinal (GI) cancers are a leading cause of cancer-related mortality worldwide. Accurate identification of lymphatic spread is essential for staging, prognosis, and treatment planning. The first metastatic lymph nodes vary depending on the primary tumor site, representing the initial echelon of nodal involvement. This pictorial essay reviews the lymphatic drainage patterns of major gastrointestinal cancers-including esophageal, gastric, pancreatic, hepatobiliary, and colorectal tumors-highlighting key nodal stations commonly involved in metastatic spread emphasizing their diagnostic and clinical relevance. By integrating multimodality imaging findings, we highlight key lymph node groups involved in metastasis, discuss their anatomical significance, and illustrate their appearance on computed tomography (CT) and magnetic resonance imaging (MRI). Understanding these patterns is critical for optimizing oncologic management.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Giuseppe D'Ippolito
- Fleury S.A. (Brazil), São Paulo, Brazil
- Federal University of São Paulo, São Paulo, Brazil
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Kotb A, Hafeji Z, Jesry F, Lintern N, Pathak S, Smith AM, Lutchman KRD, de Bruin DM, Hurks R, Heger M, Khaled YS. Intra-Operative Tumour Detection and Staging in Pancreatic Cancer Surgery: An Integrative Review of Current Standards and Future Directions. Cancers (Basel) 2024; 16:3803. [PMID: 39594758 PMCID: PMC11592681 DOI: 10.3390/cancers16223803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 10/15/2024] [Accepted: 11/06/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND Surgical resection for pancreatic ductal adenocarcinoma (PDAC) entails the excision of the primary tumour and regional lymphadenectomy. This traditional strategy is challenged by the high rate of early recurrence, suggesting inadequate disease staging. Novel methods of intra-operative staging are needed to allow surgical resection to be tailored to the disease's biology. METHODS A search of published articles on the PubMed and Embase databases was performed using the terms 'pancreas' OR 'pancreatic' AND 'intra-operative staging/detection' OR 'guided surgery'. Articles published between January 2000 and June 2023 were included. Technologies that offered intra-operative staging and tailored treatment were curated and summarised in the following integrative review. RESULTS lymph node (LN) mapping and radioimmunoguided surgery have shown promising results but lacked practicality to facilitate real-time intra-operative staging for PDAC. Fluorescence-guided surgery (FGS) offers high contrast and sensitivity, enabling the identification of cancerous tissue and positive LNs with improved precision following intravenous administration of a fluorescent agent. The unique properties of optical coherence tomography and ultrasound elastography lend themselves to be platforms for virtual biopsy intra-operatively. CONCLUSIONS Accurate intra-operative staging of PDAC, localisation of metastatic LNs, and identification of extra-pancreatic disease remain clinically unmet needs under current detection methods and staging standards. Tumour-specific FGS combined with other diagnostic and therapeutic modalities could improve tumour detection and staging in patients with PDAC.
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Affiliation(s)
- Ahmed Kotb
- Leeds Institute of Medical Research, University of Leeds, Leeds LS2 9JT, UK
| | - Zaynab Hafeji
- Leeds Institute of Medical Research, University of Leeds, Leeds LS2 9JT, UK
| | - Fadel Jesry
- Leeds Institute of Medical Research, University of Leeds, Leeds LS2 9JT, UK
| | - Nicole Lintern
- Leeds Institute of Medical Research, University of Leeds, Leeds LS2 9JT, UK
| | - Samir Pathak
- The Pancreato-Biliary Unit, St James’s University Teaching Hospital, Leeds LS9 7TF, UK
| | - Andrew M. Smith
- The Pancreato-Biliary Unit, St James’s University Teaching Hospital, Leeds LS9 7TF, UK
| | - Kishan R. D. Lutchman
- Department of Surgery, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Daniel M. de Bruin
- Department of Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Rob Hurks
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Michal Heger
- Jiaxing Key Laboratory for Photonanomedicine and Experimental Therapeutics, Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing 314001, China
| | - Yazan S. Khaled
- Leeds Institute of Medical Research, University of Leeds, Leeds LS2 9JT, UK
- The Pancreato-Biliary Unit, St James’s University Teaching Hospital, Leeds LS9 7TF, UK
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Murakami T, Shimizu H, Nojima H, Shuto K, Usui A, Kosugi C, Koda K. Diffusion-Weighted Magnetic Resonance Imaging for the Diagnosis of Lymph Node Metastasis in Patients with Biliary Tract Cancer. Cancers (Basel) 2024; 16:3143. [PMID: 39335116 PMCID: PMC11430223 DOI: 10.3390/cancers16183143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 09/03/2024] [Accepted: 09/07/2024] [Indexed: 09/30/2024] Open
Abstract
Objective: The diagnostic efficacy of the apparent diffusion coefficient (ADC) in diffusion-weighted magnetic resonance imaging (DW-MRI) for lymph node metastasis in biliary tract cancer was investigated in the present study. Methods: In total, 112 surgically resected lymph nodes from 35 biliary tract cancer patients were examined in this study. The mean and minimum ADC values of the lymph nodes as well as the long-axis and short-axis diameters of the lymph nodes were assessed by computed tomography (CT). The relationship between these parameters and the presence of histological lymph node metastasis was evaluated. Results: Histological lymph node metastasis was detected in 31 (27.7%) out of 112 lymph nodes. Metastatic lymph nodes had a significantly larger short-axis diameter compared with non-metastatic lymph nodes (p = 0.002), but the long-axis diameter was not significantly different between metastatic and non-metastatic lymph nodes. The mean and minimum ADC values for metastatic lymph nodes were significantly reduced compared with those for non-metastatic lymph nodes (p < 0.001 for both). However, the minimum ADC value showed the highest accuracy for the diagnosis of histological lymph node metastasis, with an area under the curve of 0.877, sensitivity of 87.1%, specificity of 82.7%, and accuracy of 83.9%. Conclusions: The minimum ADC value in DW-MRI is highly effective for the diagnosis of lymph node metastasis in biliary tract cancer. Accurate preoperative diagnosis of lymph node metastasis in biliary tract cancer should enable the establishment of more appropriate treatment strategies.
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Affiliation(s)
- Takashi Murakami
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara 299-0112, Japan
| | - Hiroaki Shimizu
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara 299-0112, Japan
| | - Hiroyuki Nojima
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara 299-0112, Japan
| | - Kiyohiko Shuto
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara 299-0112, Japan
| | - Akihiro Usui
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara 299-0112, Japan
| | - Chihiro Kosugi
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara 299-0112, Japan
| | - Keiji Koda
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara 299-0112, Japan
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Yamada S, Hashimoto D, Yamamoto T, Yamaki S, Oshima K, Murotani K, Sekimoto M, Nakao A, Satoi S. Reconsideration of the clinical impact of neoadjuvant therapy in resectable and borderline resectable pancreatic cancer: A dual-institution collaborative clinical study. Pancreatology 2024; 24:592-599. [PMID: 38548551 DOI: 10.1016/j.pan.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/05/2024] [Accepted: 03/23/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE We investigated true indication of neoadjuvant therapy (NAT) in resectable pancreatic cancer and the optimal surgical timing in borderline resectable pancreatic cancer. METHODS A total of 687 patients with resectable or borderline resectable pancreatic cancer were enrolled. Survival analysis was performed by intention-to-treat analysis and propensity score matching (PSM) was conducted. RESULTS In resectable disease, the NAT group showed better overall survival (OS) compared with the upfront group. Multivariate analysis identified CA19-9 level (≥100 U/mL) and lymph node metastasis to be prognostic factors, and a tumor size of 25 mm was the optimal cut-off value to predict lymph node metastasis. There was no significant survival difference between patients with a tumor size ≤25 mm and CA19-9 < 100 U/mL and those in the NAT group. In borderline resectable disease, OS in the NAT group was significantly better than that in the upfront group. CEA (≥5 ng/mL) and CA19-9 (≥100 U/mL) were identified as prognostic factors; however, the OS of patients fulfilling these factors was worse than that of the NAT group. CONCLUSIONS NAT could be unnecessary in patients with tumor size ≤25 mm and CA19-9 < 100 U/mL in resectable disease. In borderline resectable disease, surgery should be delayed until tumor marker levels are well controlled.
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Affiliation(s)
- Suguru Yamada
- Department of Gastroenterological Surgery, Nagoya Central Hospital, Japan
| | | | | | - So Yamaki
- Department of Surgery, Kansai Medical University, Japan
| | - Kenji Oshima
- Department of Gastroenterological Surgery, Nagoya Central Hospital, Japan
| | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume University, Japan
| | - Mitsugu Sekimoto
- Division of Surgical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Akimasa Nakao
- Department of Gastroenterological Surgery, Nagoya Central Hospital, Japan
| | - Sohei Satoi
- Department of Surgery, Kansai Medical University, Japan; Division of Surgical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Li S, Jiang D, Jiang L, Yan S, Liu L, Ruan G, Zhou X, Zhuo S. Dual-energy computed tomography in a multiparametric regression model for diagnosing lymph node metastases in pancreatic ductal adenocarcinoma. Cancer Imaging 2024; 24:38. [PMID: 38504330 PMCID: PMC10953218 DOI: 10.1186/s40644-024-00687-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/10/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVE To investigate the diagnostic value of dual-energy computed tomography (DECT) quantitative parameters in the identification of regional lymph node metastasis in pancreatic ductal adenocarcinoma (PDAC). METHODS This retrospective diagnostic study assessed 145 patients with pathologically confirmed pancreatic ductal adenocarcinoma from August 2016-October 2020. Quantitative parameters for targeted lymph nodes were measured using DECT, and all parameters were compared between benign and metastatic lymph nodes to determine their diagnostic value. A logistic regression model was constructed; the receiver operator characteristics curve was plotted; the area under the curve (AUC) was calculated to evaluate the diagnostic efficacy of each energy DECT parameter; and the DeLong test was used to compare AUC differences. Model evaluation was used for correlation analysis of each DECT parameter. RESULTS Statistical differences in benign and metastatic lymph nodes were found for several parameters. Venous phase iodine density had the highest diagnostic efficacy as a single parameter, with AUC 0.949 [95% confidence interval (CI):0.915-0.972, threshold: 3.95], sensitivity 79.80%, specificity 96.00%, and accuracy 87.44%. Regression models with multiple parameters had the highest diagnostic efficacy, with AUC 0.992 (95% CI: 0.967-0.999), sensitivity 95.96%, specificity 96%, and accuracy 94.97%, which was higher than that for a single DECT parameter, and the difference was statistically significant. CONCLUSION Among all DECT parameters for regional lymph node metastasis in PDAC, venous phase iodine density has the highest diagnostic efficacy as a single parameter, which is convenient for use in clinical settings, whereas a multiparametric regression model has higher diagnostic value compared with the single-parameter model.
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Affiliation(s)
- Sheng Li
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China
| | - Dongping Jiang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China
| | - Linling Jiang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China
| | - Shumei Yan
- Department of pathology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China
| | - Lizhi Liu
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China
| | - Guangying Ruan
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China
| | - Xuhui Zhou
- Department of Radiology, the Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518036, China.
| | - Shuiqing Zhuo
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China.
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Adham S, Ferri M, Lee SY, Larocque N, Alwahbi OA, Ruo L, van der Pol CB. Pancreatic ductal adenocarcinoma (PDAC) regional nodal disease at standard lymphadenectomy: is MRI accurate for identifying node-positive patients? Eur Radiol 2023; 33:5976-5983. [PMID: 37004569 DOI: 10.1007/s00330-023-09597-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE To determine the accuracy of qualitative and quantitative MRI features for the diagnosis of pathologic regional lymph nodes at standard lymphadenectomy in patients with pancreatic ductal adenocarcinoma (PDAC). METHODS All adult patients with pancreatic MRI performed from 2011 to 2021 within 3 months of a pancreaticoduodenectomy were eligible for inclusion in this single-center retrospective cohort study. Regional nodes at standard lymphadenectomy were independently reviewed by two fellowship-trained abdominal radiologists for the following qualitative features: heterogeneous T2 signal, round shape, indistinct margin, peri-nodal fat stranding, and restricted diffusion greater than the spleen. Quantitative characteristics including primary tumor size, largest node short- and long-axes length, number of regional nodes, absolute apparent diffusion coefficient (ADC) values, and ADC node-to-spleen signal index were assessed. Analysis was at the patient-level with surgical pathology as the reference standard. RESULTS Of 75 patients, 85% (64/75) were positive for regional nodal disease on histopathology. None of the qualitative variables evaluated on MRI was associated with pathologic nodes. Median primary tumor maximum diameter was slightly larger for patients with pathologic nodes compared to those without (18 mm (10-42 mm) vs 16 mm (9-22 mm), p = 0.027). None of the other quantitative features was associated with pathologic nodes. Radiologist opinion was not associated with pathologic nodes (p = 0.520). Interobserver agreement was fair (kappa = 0.257). CONCLUSIONS Lymph node morphologic features and radiologist opinion using MRI are of limited value for diagnosing PDAC regional nodal disease. Improved diagnostic techniques are needed given the prognostic implications of pathologic lymph nodes in these patients. KEY POINTS • Multiple lymph node morphologic features routinely assessed on MRI for malignancies elsewhere in the body are likely not applicable when assessing for pancreatic ductal adenocarcinoma nodal disease. • Interobserver agreement for the presence or absence of pancreatic ductal adenocarcinoma lymph node morphologic features on MRI is fair (kappa = 0.257). • Many more lymph nodes are resected at PDAC standard lymphadenectomy than are detectable on MRI, median 25 vs 5 (p < 0.001), suggesting improved diagnostic techniques are needed to identify PDAC nodal disease.
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Affiliation(s)
- Sami Adham
- Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Melanie Ferri
- Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Stefanie Y Lee
- Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Natasha Larocque
- Department of Radiology, McMaster University, Hamilton, ON, Canada
- Hamilton General Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Omar A Alwahbi
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Leyo Ruo
- Department of Radiology, McMaster University, Hamilton, ON, Canada
- Department of Surgery, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Christian B van der Pol
- Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada.
- Department of Radiology, McMaster University, Hamilton, ON, Canada.
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Diagnosis of Metastatic Lymph Nodes in Patients With Hepatocellular Carcinoma Using Dual-Energy Computed Tomography. J Comput Assist Tomogr 2022; 47:00004728-990000000-00109. [PMID: 36573327 DOI: 10.1097/rct.0000000000001429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Our study aimed to investigate the role of quantitative parameters derived from dual-energy computed tomography (DECT) in discriminating metastatic from nonmetastatic lymph nodes in hepatocellular carcinoma (HCC). METHODS Forty-two patients (34 males; mean age, 53.7 years) with HCC underwent unenhanced computed tomography scans and triple-phase DECT scans of the upper abdomen. A total of 72 suspected lymph nodes were resected, including 43 nonmetastatic and 29 metastatic lymph nodes. The maximum short-axis diameter of the lymph nodes, iodine concentration, normalized iodine concentration (NIC), and slope of the spectral curve were analyzed for the HCC primary lesions and the suspected lymph nodes. Lymph node metastasis was confirmed by pathologic examination. RESULTS A maximum short-axis diameter of >10 mm had a sensitivity and a specificity of 75.9% (22/29) and 53.5% (23/43) in diagnosing metastatic lymph nodes. The iodine concentration, NIC, and slope of the spectral curve of the nonmetastatic lymph nodes were significantly higher than those of the primary HCC lesions and the metastatic lymph nodes (all P < 0.05). Among all the analyzed spectral parameters, the NIC in the arterial phase had the highest sensitivity and specificity of 88.4% and 86.2% in diagnosing metastatic lymph nodes. CONCLUSIONS The arterial phase NIC of DECT has superior diagnostic performance than the traditional lymph node size in diagnosing metastatic lymph nodes in HCC.
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Li Q, Song Z, Zhang D, Li X, Liu Q, Yu J, Li Z, Zhang J, Ren X, Wen Y, Tang Z. Feasibility of a CT-based lymph node radiomics nomogram in detecting lymph node metastasis in PDAC patients. Front Oncol 2022; 12:992906. [PMID: 36276058 PMCID: PMC9579427 DOI: 10.3389/fonc.2022.992906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/20/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives To investigate the potential value of a contrast enhanced computed tomography (CECT)-based radiological-radiomics nomogram combining a lymph node (LN) radiomics signature and LNs’ radiological features for preoperative detection of LN metastasis in patients with pancreatic ductal adenocarcinoma (PDAC). Materials and methods In this retrospective study, 196 LNs in 61 PDAC patients were enrolled and divided into the training (137 LNs) and validation (59 LNs) cohorts. Radiomic features were extracted from portal venous phase images of LNs. The least absolute shrinkage and selection operator (LASSO) regression algorithm with 10-fold cross-validation was used to select optimal features to determine the radiomics score (Rad-score). The radiological-radiomics nomogram was developed by using significant predictors of LN metastasis by multivariate logistic regression (LR) analysis in the training cohort and validated in the validation cohort independently. Its diagnostic performance was assessed by receiver operating characteristic curve (ROC), decision curve (DCA) and calibration curve analyses. Results The radiological model, including LN size, and margin and enhancement pattern (three significant predictors), exhibited areas under the curves (AUCs) of 0.831 and 0.756 in the training and validation cohorts, respectively. Nine radiomic features were used to construct a radiomics model, which showed AUCs of 0.879 and 0.804 in the training and validation cohorts, respectively. The radiological-radiomics nomogram, which incorporated the LN Rad-score and the three LNs’ radiological features, performed better than the Rad-score and radiological models individually, with AUCs of 0.937 and 0.851 in the training and validation cohorts, respectively. Calibration curve analysis and DCA revealed that the radiological-radiomics nomogram showed satisfactory consistency and the highest net benefit for preoperative diagnosis of LN metastasis. Conclusions The CT-based LN radiological-radiomics nomogram may serve as a valid and convenient computer-aided tool for personalized risk assessment of LN metastasis and help clinicians make appropriate clinical decisions for PADC patients.
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Affiliation(s)
- Qian Li
- Department of Radiology, Chongqing Medical University, Chongqing, China
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, China
- Chongqing School, University of Chinese Academy of Sciences, Chongqing, China
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Zuhua Song
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Dan Zhang
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Xiaojiao Li
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Qian Liu
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Jiayi Yu
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Zongwen Li
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Jiayan Zhang
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Xiaofang Ren
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Youjia Wen
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Zhuoyue Tang
- Department of Radiology, Chongqing Medical University, Chongqing, China
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, China
- Chongqing School, University of Chinese Academy of Sciences, Chongqing, China
- Department of Radiology, Chongqing General Hospital, Chongqing, China
- *Correspondence: Zhuoyue Tang,
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Guha A, Goda JS, Dasgupta A, Mahajan A, Halder S, Gawde J, Talole S. Classifying primary central nervous system lymphoma from glioblastoma using deep learning and radiomics based machine learning approach - a systematic review and meta-analysis. Front Oncol 2022; 12:884173. [PMID: 36263203 PMCID: PMC9574102 DOI: 10.3389/fonc.2022.884173] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/07/2022] [Indexed: 01/06/2023] Open
Abstract
BackgroundGlioblastoma (GBM) and primary central nervous system lymphoma (PCNSL) are common in elderly yet difficult to differentiate on MRI. Their management and prognosis are quite different. Recent surge of interest in predictive analytics, using machine learning (ML) from radiomic features and deep learning (DL) for diagnosing, predicting response and prognosticating disease has evinced interest among radiologists and clinicians. The objective of this systematic review and meta-analysis was to evaluate the deep learning & ML algorithms in classifying PCNSL from GBM.MethodsThe authors performed a systematic review of the literature from MEDLINE, EMBASE and the Cochrane central trials register for the search strategy in accordance with PRISMA guidelines to select and evaluate studies that included themes of ML, DL, AI, GBM, PCNSL. All studies reporting on ML algorithms or DL that for differentiating PCNSL from GBM on MR imaging were included. These studies were further narrowed down to focus on works published between 2018 and 2021. Two researchers independently conducted the literature screening, database extraction and risk bias assessment. The extracted data was synthesised and analysed by forest plots. Outcomes assessed were test characteristics such as accuracy, sensitivity, specificity and balanced accuracy.ResultsTen articles meeting the eligibility criteria were identified addressing use of ML and DL in training and validation classifiers to distinguish PCNSL from GBM on MR imaging. The total sample size was 1311 in the included studies. ML approach was used in 6 studies while DL in 4 studies. The lowest reported sensitivity was 80%, while the highest reported sensitivity was 99% in studies in which ML and DL was directly compared with the gold standard histopathology. The lowest reported specificity was 87% while the highest reported specificity was 100%. The highest reported balanced accuracy was 100% and the lowest was 84%.ConclusionsExtensive search of the database revealed a limited number of studies that have applied ML or DL to differentiate PCNSL from GBM. Of the currently published studies, Both DL & ML algorithms have demonstrated encouraging results and certainly have the potential to aid neurooncologists in taking preoperative decisions in the future leading to not only reduction in morbidities but also be cost effective.
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Affiliation(s)
- Amrita Guha
- Department of Radio Diagnosis, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
- *Correspondence: Amrita Guha, ; Jayant S. Goda,
| | - Jayant S. Goda
- Department of Radio Diagnosis, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
- *Correspondence: Amrita Guha, ; Jayant S. Goda,
| | - Archya Dasgupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
| | - Abhishek Mahajan
- Department of Radio Diagnosis, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
| | - Soutik Halder
- Department of Biostatistics, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
| | - Jeetendra Gawde
- Department of Biostatistics, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
| | - Sanjay Talole
- Department of Biostatistics, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
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Shi YJ, Liu BN, Li XT, Zhu HT, Wei YY, Zhao B, Sun SS, Sun YS, Hao CY. Establishment of a multi-parameters MRI model for predicting small lymph nodes metastases (<10 mm) in patients with resected pancreatic ductal adenocarcinoma. Abdom Radiol (NY) 2022; 47:3217-3228. [PMID: 34800159 PMCID: PMC9388457 DOI: 10.1007/s00261-021-03347-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate the potential role of MR findings and DWI parameters in predicting small regional lymph nodes metastases (with short-axis diameter < 10 mm) in pancreatic ductal adenocarcinomas (PDACs). METHODS A total of 127 patients, 82 in training group and 45 in testing group, with histopathologically diagnosed PDACs who underwent pancreatectomy were retrospectively analyzed. PDACs were divided into two groups of positive and negative lymph node metastases (LNM) based on the pathological results. Pancreatic cancer characteristics, short axis of largest lymph node, and DWI parameters of PDACs were evaluated. RESULTS Univariate and multivariate analyses showed that extrapancreatic distance of tumor invasion, short-axis diameter of the largest lymph node, and mean diffusivity of tumor were independently associated with small LNM in patients with PDACs. The combining MRI diagnostic model yielded AUCs of 0.836 and 0.873, and accuracies of 81.7% and 80% in the training and testing groups. The AUC of the MRI model for predicting LNM was higher than that of subjective MRI diagnosis in the training group (rater 1, P = 0.01; rater 2, 0.008) and in a testing group (rater 1, P = 0.036; rater 2, 0.024). Comparing the subjective diagnosis, the error rate of the MRI model was decreased. The defined LNM-positive group by the MRI model showed significantly inferior overall survival compared to the negative group (P = 0.006). CONCLUSIONS The MRI model showed excellent performance for individualized and noninvasive prediction of small regional LNM in PDACs. It may be used to identify PDACs with small LNM and contribute to determining an appropriate treatment strategy for PDACs.
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Affiliation(s)
- Yan-Jie Shi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No.52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Bo-Nan Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Hepato-Pancreato-Biliary Surgery, Peking University Cancer Hospital & Institute, No.52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Xiao-Ting Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No.52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Hai-Tao Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No.52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Yi-Yuan Wei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No.52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Bo Zhao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No.52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Shao-Shuai Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No.52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No.52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China.
| | - Chun-Yi Hao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Hepato-Pancreato-Biliary Surgery, Peking University Cancer Hospital & Institute, No.52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China.
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Shi L, Wang L, Wu C, Wei Y, Zhang Y, Chen J. Preoperative Prediction of Lymph Node Metastasis of Pancreatic Ductal Adenocarcinoma Based on a Radiomics Nomogram of Dual-Parametric MRI Imaging. Front Oncol 2022; 12:927077. [PMID: 35875061 PMCID: PMC9298539 DOI: 10.3389/fonc.2022.927077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/06/2022] [Indexed: 12/12/2022] Open
Abstract
PurposeThis study aims to uncover and validate an MRI-based radiomics nomogram for detecting lymph node metastasis (LNM) in pancreatic ductal adenocarcinoma (PDAC) patients prior to surgery.Materials and MethodsWe retrospectively collected 141 patients with pathologically confirmed PDAC who underwent preoperative T2-weighted imaging (T2WI) and portal venous phase (PVP) contrast-enhanced T1-weighted imaging (T1WI) scans between January 2017 and December 2021. The patients were randomly divided into training (n = 98) and validation (n = 43) cohorts at a ratio of 7:3. For each sequence, 1037 radiomics features were extracted and analyzed. After applying the gradient-boosting decision tree (GBDT), the key MRI radiomics features were selected. Three radiomics scores (rad-score 1 for PVP, rad-score 2 for T2WI, and rad-score 3 for T2WI combined with PVP) were calculated. Rad-score 3 and clinical independent risk factors were combined to construct a nomogram for the prediction of LNM of PDAC by multivariable logistic regression analysis. The predictive performances of the rad-scores and the nomogram were assessed by the area under the operating characteristic curve (AUC), and the clinical utility of the radiomics nomogram was assessed by decision curve analysis (DCA).ResultsSix radiomics features of T2WI, eight radiomics features of PVP and ten radiomics features of T2WI combined with PVP were found to be associated with LNM. Multivariate logistic regression analysis showed that rad-score 3 and MRI-reported LN status were independent predictors. In the training and validation cohorts, the AUCs of rad-score 1, rad-score 2 and rad-score 3 were 0.769 and 0.751, 0.807 and 0.784, and 0.834 and 0.807, respectively. The predictive value of rad-score 3 was similar to that of rad-score 1 and rad-score 2 in both the training and validation cohorts (P > 0.05). The radiomics nomogram constructed by rad-score 3 and MRI-reported LN status showed encouraging clinical benefit, with an AUC of 0.845 for the training cohort and 0.816 for the validation cohort.ConclusionsThe radiomics nomogram derived from the rad-score based on MRI features and MRI-reported lymph status showed outstanding performance for the preoperative prediction of LNM of PDAC.
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Affiliation(s)
- Lin Shi
- Cancer Center, Department of Radiology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Ling Wang
- Cancer Center, Department of Radiology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Cuiyun Wu
- Cancer Center, Department of Radiology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Yuguo Wei
- Precision Health Institution, General Electric Healthcare, Hangzhou, China
| | - Yang Zhang
- Cancer Center, Department of Radiology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Junfa Chen
- Cancer Center, Department of Radiology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- *Correspondence: Junfa Chen,
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12
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Tseng DSJ, Pranger BK, van Leeuwen MS, Pennings JP, Brosens LA, Mohammad NH, de Meijer VE, van Santvoort HC, Erdmann JI, Molenaar IQ. The Role of CT in Assessment of Extraregional Lymph Node Involvement in Pancreatic and Periampullary Cancer: A Diagnostic Accuracy Study. Radiol Imaging Cancer 2021; 3:e200014. [PMID: 33817647 DOI: 10.1148/rycan.2021200014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 10/15/2020] [Accepted: 11/18/2020] [Indexed: 01/06/2023]
Abstract
Purpose To investigate the diagnostic accuracy of CT in assessing extraregional lymph node metastases in pancreatic head and periampullary cancer. Materials and Methods This prospective observational cohort study was performed at two tertiary hepatopancreatobiliary (HPB) referral centers between March 2013 and December 2014. Patients undergoing pancreatoduodenectomy or bypass surgery with or without palliative radiofrequency ablation were included. Extraregional lymph node involvement was defined as positive lymph nodes in the aortocaval window. Two expert HPB radiologists assessed aortocaval lymph nodes at preoperative CT according to a standardized protocol. All tissue from the aortocaval window was collected intraoperatively. Positive histopathologic finding was the reference standard. Analysis of predictive values and diagnostic accuracy was performed. Results A total of 198 consecutive patients (mean age, 66 years; range, 39-86 years; 105 men) with pancreatic head or periampullary carcinoma were included. In 70% of patients, a pancreatoduodenectomy was performed, 4% underwent total pancreatectomy, 4% underwent radiofrequency ablation, and 22% underwent bypass surgery. Forty-four patients (22%) had histologically positive aortocaval lymph nodes. Negative predictive value of CT in assessing aortocaval lymph nodes was 80% for both observers, and positive predictive value was 31%-33%. Overall diagnostic accuracy was 69%-70%. Conclusion CT has a low diagnostic accuracy in assessing extraregional lymph node metastases in patients suspected of having pancreatic or periampullary cancer.Keywords: CT, Abdomen/GI, Pancreas, Oncology© RSNA, 2021.
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Affiliation(s)
- Dorine S J Tseng
- Department of Surgery, University Medical Center Utrecht and St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, Heidelberglaan 100, HG G04.228, PO Box 85500, 3508 GA, Utrecht, the Netherlands (D.S.J.T., H.C.v.S., I.Q.M.); University of Groningen and University Medical Center Groningen, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Groningen, the Netherlands (B.K.P., V.E.d.M., J.I.E.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (M.S.v.L.); University of Groningen and University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands (J.P.P.); Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands (L.A.B.); Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (N.H.M.)
| | - Bobby K Pranger
- Department of Surgery, University Medical Center Utrecht and St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, Heidelberglaan 100, HG G04.228, PO Box 85500, 3508 GA, Utrecht, the Netherlands (D.S.J.T., H.C.v.S., I.Q.M.); University of Groningen and University Medical Center Groningen, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Groningen, the Netherlands (B.K.P., V.E.d.M., J.I.E.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (M.S.v.L.); University of Groningen and University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands (J.P.P.); Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands (L.A.B.); Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (N.H.M.)
| | - Maarten S van Leeuwen
- Department of Surgery, University Medical Center Utrecht and St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, Heidelberglaan 100, HG G04.228, PO Box 85500, 3508 GA, Utrecht, the Netherlands (D.S.J.T., H.C.v.S., I.Q.M.); University of Groningen and University Medical Center Groningen, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Groningen, the Netherlands (B.K.P., V.E.d.M., J.I.E.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (M.S.v.L.); University of Groningen and University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands (J.P.P.); Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands (L.A.B.); Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (N.H.M.)
| | - Jan Pieter Pennings
- Department of Surgery, University Medical Center Utrecht and St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, Heidelberglaan 100, HG G04.228, PO Box 85500, 3508 GA, Utrecht, the Netherlands (D.S.J.T., H.C.v.S., I.Q.M.); University of Groningen and University Medical Center Groningen, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Groningen, the Netherlands (B.K.P., V.E.d.M., J.I.E.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (M.S.v.L.); University of Groningen and University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands (J.P.P.); Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands (L.A.B.); Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (N.H.M.)
| | - Lodewijk A Brosens
- Department of Surgery, University Medical Center Utrecht and St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, Heidelberglaan 100, HG G04.228, PO Box 85500, 3508 GA, Utrecht, the Netherlands (D.S.J.T., H.C.v.S., I.Q.M.); University of Groningen and University Medical Center Groningen, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Groningen, the Netherlands (B.K.P., V.E.d.M., J.I.E.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (M.S.v.L.); University of Groningen and University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands (J.P.P.); Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands (L.A.B.); Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (N.H.M.)
| | - Nadja Haj Mohammad
- Department of Surgery, University Medical Center Utrecht and St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, Heidelberglaan 100, HG G04.228, PO Box 85500, 3508 GA, Utrecht, the Netherlands (D.S.J.T., H.C.v.S., I.Q.M.); University of Groningen and University Medical Center Groningen, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Groningen, the Netherlands (B.K.P., V.E.d.M., J.I.E.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (M.S.v.L.); University of Groningen and University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands (J.P.P.); Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands (L.A.B.); Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (N.H.M.)
| | - Vincent E de Meijer
- Department of Surgery, University Medical Center Utrecht and St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, Heidelberglaan 100, HG G04.228, PO Box 85500, 3508 GA, Utrecht, the Netherlands (D.S.J.T., H.C.v.S., I.Q.M.); University of Groningen and University Medical Center Groningen, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Groningen, the Netherlands (B.K.P., V.E.d.M., J.I.E.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (M.S.v.L.); University of Groningen and University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands (J.P.P.); Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands (L.A.B.); Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (N.H.M.)
| | - Hjalmar C van Santvoort
- Department of Surgery, University Medical Center Utrecht and St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, Heidelberglaan 100, HG G04.228, PO Box 85500, 3508 GA, Utrecht, the Netherlands (D.S.J.T., H.C.v.S., I.Q.M.); University of Groningen and University Medical Center Groningen, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Groningen, the Netherlands (B.K.P., V.E.d.M., J.I.E.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (M.S.v.L.); University of Groningen and University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands (J.P.P.); Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands (L.A.B.); Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (N.H.M.)
| | - Joris I Erdmann
- Department of Surgery, University Medical Center Utrecht and St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, Heidelberglaan 100, HG G04.228, PO Box 85500, 3508 GA, Utrecht, the Netherlands (D.S.J.T., H.C.v.S., I.Q.M.); University of Groningen and University Medical Center Groningen, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Groningen, the Netherlands (B.K.P., V.E.d.M., J.I.E.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (M.S.v.L.); University of Groningen and University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands (J.P.P.); Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands (L.A.B.); Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (N.H.M.)
| | - I Quintus Molenaar
- Department of Surgery, University Medical Center Utrecht and St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, Heidelberglaan 100, HG G04.228, PO Box 85500, 3508 GA, Utrecht, the Netherlands (D.S.J.T., H.C.v.S., I.Q.M.); University of Groningen and University Medical Center Groningen, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Groningen, the Netherlands (B.K.P., V.E.d.M., J.I.E.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (M.S.v.L.); University of Groningen and University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands (J.P.P.); Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands (L.A.B.); Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (N.H.M.)
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Value of apparent diffusion coefficient for differentiating peripancreatic tuberculous lymphadenopathy from metastatic lymphadenopathy. Abdom Radiol (NY) 2020; 45:3163-3171. [PMID: 32240328 DOI: 10.1007/s00261-020-02501-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate effectiveness of the apparent diffusion coefficient (ADC) values of the peripancreatic lymphadenopathy to differentiate tuberculous lymphadenopathy from metastatic lymphadenopathy. MATERIALS AND METHODS Twenty-nine patients with 65 peripancreatic necrotic tuberculous lymphadenopathy and 31 patients with 47 peripancreatic necrotic metastatic lymphadenopathy from pancreatic ductal adenocarcinoma, who underwent magnetic resonance imaging (MRI), were included in this study. MRI features in the T1-weighted image (WI), T2WI, and diffusion-weighted image were analyzed. The ADC values of necrotic and non-necrotic portions of the lymph nodes were measured and compared using t test. Receiver operating characteristic analysis was performed to obtain the optimal ADC threshold value and diagnostic accuracy for differentiating tuberculous lymphadenopathy from metastatic lymphadenopathy. RESULTS On T2WI, the signal intensity of necrotic portions was variable in tuberculous lymphadenopathy, but was mostly high in metastatic lymphadenopathy. The mean ADCs of necrotic portions of tuberculous lymphadenopathy were significantly lower than those of metastatic lymphadenopathy ([0.919 ± 0.272] × 10-3 mm2/s vs. [1.553 ± 0.406] × 10-3 mm2/s, p < 0.001). Receiver operating characteristic analysis for differentiating tuberculous from metastatic lymphadenopathy demonstrated an area under the curve for the ADC values of necrotic portions of 0.929 (95% CI, 0.865-0.969) with an ADC threshold of 1.022. The sensitivity and specificity for the differentiation of tuberculous from metastatic lymphadenopathy were 80.0% and 97.8%, respectively. CONCLUSION The ADC values of necrotic portions of peripancreatic lymphadenopathy may be useful for differentiating tuberculous from metastatic lymphadenopathy.
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Anger F, Döring A, van Dam J, Lock JF, Klein I, Bittrich M, Germer CT, Wiegering A, Kunzmann V, van Eijck C, Löb S. Impact of Borderline Resectability in Pancreatic Head Cancer on Patient Survival: Biology Matters According to the New International Consensus Criteria. Ann Surg Oncol 2020; 28:2325-2336. [PMID: 32920720 PMCID: PMC7940298 DOI: 10.1245/s10434-020-09100-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/18/2020] [Indexed: 12/19/2022]
Abstract
Background International consensus criteria (ICC) have redefined borderline resectability for pancreatic ductal adenocarcinoma (PDAC) according to three dimensions: anatomical (BR-A), biological (BR-B), and conditional (BR-C). The present definition acknowledges that resectability is not just about the anatomic relationship between the tumour and vessels but that biological and conditional dimensions also are important. Methods Patients’ tumours were retrospectively defined borderline resectable according to ICC. The study cohort was grouped into either BR-A or BR-B and compared with patients considered primarily resectable (R). Differences in postoperative complications, pathological reports, overall (OS), and disease-free survival were assessed. Results A total of 345 patients underwent resection for PDAC. By applying ICC in routine preoperative assessment, 30 patients were classified as stage BR-A and 62 patients as stage BR-B. In total, 253 patients were considered R. The cohort did not contain BR-C patients. No differences in postoperative complications were detected. Median OS was significantly shorter in BR-A (15 months) and BR-B (12 months) compared with R (20 months) patients (BR-A vs. R: p = 0.09 and BR-B vs. R: p < 0.001). CA19-9, as the determining factor of BR-B patients, turned out to be an independent prognostic risk factor for OS. Conclusions Preoperative staging defining surgical resectability in PDAC according to ICC is crucial for patient survival. Patients with PDAC BR-B should be considered for multimodal neoadjuvant therapy even if considered anatomically resectable.
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Affiliation(s)
- Friedrich Anger
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, Julius Maximilians University Wuerzburg, Würzburg, Germany
| | - Anna Döring
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, Julius Maximilians University Wuerzburg, Würzburg, Germany
| | - Jacob van Dam
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Johan Friso Lock
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, Julius Maximilians University Wuerzburg, Würzburg, Germany
| | - Ingo Klein
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, Julius Maximilians University Wuerzburg, Würzburg, Germany
| | - Max Bittrich
- Department of Internal Medicine II, Julius Maximilians University Wuerzburg, Würzburg, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, Julius Maximilians University Wuerzburg, Würzburg, Germany.,Comprehensive Cancer Centre Mainfranken, Julius Maximilians University Wuerzburg, Würzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, Julius Maximilians University Wuerzburg, Würzburg, Germany.,Comprehensive Cancer Centre Mainfranken, Julius Maximilians University Wuerzburg, Würzburg, Germany
| | - Volker Kunzmann
- Department of Internal Medicine II, Julius Maximilians University Wuerzburg, Würzburg, Germany.,Comprehensive Cancer Centre Mainfranken, Julius Maximilians University Wuerzburg, Würzburg, Germany
| | - Casper van Eijck
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Stefan Löb
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, Julius Maximilians University Wuerzburg, Würzburg, Germany.
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Differential and prognostic MRI features of gallbladder neuroendocrine tumors and adenocarcinomas. Eur Radiol 2020; 30:2890-2901. [PMID: 32025835 DOI: 10.1007/s00330-019-06588-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 10/22/2019] [Accepted: 11/12/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To identify MRI features that are helpful for the differentiation of gallbladder neuroendocrine tumors (GB-NETs) from gallbladder adenocarcinomas (GB-ADCs) and to evaluate their prognostic values. METHODS Between January 2008 and December 2018, we retrospectively enrolled patients who underwent MRI for GB malignancy. Two radiologists independently assessed the MRI findings and reached a consensus. Significant MRI features, which distinguish GB-NETs from GB-ADCs, were identified. Cox regression analyses were performed to find MRI features that were prognostic for overall survival. RESULTS There were 63 patients with GB-NETs (n = 21) and GB-ADCs (n = 42). Compared with GB-ADCs, GB-NETs more frequently demonstrated the following MRI features: well-defined margins, intact overlying mucosa, and thick rim contrast enhancement and/or diffusion restriction (ps < 0.001). Liver metastases were more common and demonstrated thick rim contrast enhancement and diffusion restriction in GB-NETs (ps < 0.001). Lymph node (LN) metastasis showed thick rim diffusion restriction more often in GB-NETs than in GB-ADCs (p = 0.009). On quantitative analysis, the sizes of the GB mass and metastatic LNs in GB-NETs were larger than those in GB-ADCs (p = 0.002 and p = 0.010, respectively). The ratio of apparent diffusion coefficient values between the lesion and the spleen was lower in the GB mass, liver metastases, and LN metastases of GB-NETs than those of GB-ADCs (p < 0.001, p = 0.017, and p < 0.001, respectively). Survival analysis revealed that a large metastatic LN (hazard ratio 1.737; 95% confidence interval, 1.112-2.712) was the only poor prognostic factor (p = 0.015). CONCLUSION Several MRI features aided in differentiating between GB-NETs and GB-ADCs. A large metastatic LN was associated with poor survival. KEY POINTS • Compared with gallbladder adenocarcinomas (GB-ADCs), neuroendocrine tumors (GB-NETs) and their metastases to the liver and lymph nodes more frequently demonstrated a thick rim appearance on contrast-enhanced MRI and diffusion-weighted images. • The ratio of apparent diffusion coefficient values between the lesion and the spleen was significantly lower for the primary mass, liver metastases, and lymph node metastases of GB-NETs than for those of GB-ADCs. • A large metastatic lymph node was the only poor prognostic factor for overall survival in patients with GB-NETs and GB-ADCs.
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sun Z, Hu S, Li J, Wang T, Xie Z, Jin L. An application study of CT perfusion imaging in assessing metastatic involvement of perigastric lymph nodes in patients with T1 gastric cancer. Br J Radiol 2020; 93:20190790. [PMID: 31778314 PMCID: PMC7055441 DOI: 10.1259/bjr.20190790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/30/2019] [Accepted: 11/25/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To assess metastatic involvement of perigastric lymph nodes (PLNs) in patients with T1 gastric cancer by using CT perfusion imaging (CTPI). METHODS A total of 82 annotated PLNs of 33 patients with T1 gastric cancer confirmed by endoscopic ultrasonography underwent CTPI and portal phase CT scan before operation. The scan data were post-processed to acquire perfusion maps and calculate perfusion parameters including blood flow (BF) and permeability surface (PS). A radiologist measured the short axis diameters and perfusion parameters of PLNs. According to the post-operative pathology result, PLNs were divided into two groups: metastatic and inflammatory LNs. Perfusion parameters values and the size of PLNs between two groups were respectively compared statistically by t-test, and a receiver operating characteristic curve analysis was used to determine the optimal diagnostic cut-off value with sensitivity, specificity and area under the curve. RESULTS Examined 82 PLNs were metastatic in 45 (54.9%) and inflammatory in 37 (45.1%). The mean values of perfusion parameters and the short axis diameters in metastatic and inflammatory PLNs, respectively, were BF of 97.48 vs 81.21 ml/100 mg /min (p < 0.001), PS of 45.11 vs 36.80 ml/100 mg /min (p < 0.001), and the size of 1.51 cm vs 1.29 cm (p = 0.059). The sensitivity of 84.4%, specificity of 67.6% and area under the curve of 0.826 for BF with cut-off value of 88.89 ml/100 mg /min for differentiating metastatic from inflammatory nodes were higher than those of PS or the size of PLNs (p < 0.001). CONCLUSION CT perfusion parameters values were different between metastatic and inflammatory PLNs in T1 gastric cancer. BF value may be the most reliable diagnostic marker of metastatic PLNs, and it is helpful for clinicians to choose treatment modality or management plan in T1 gastric cancer patients. ADVANCES IN KNOWLEDGE CTPI gives information on vascularization of LNs.BF value might be a more effective marker than PS or the size of LNs for differentiating metastatic from inflammatory LNs in patients with T1 gastric cancer.
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Affiliation(s)
- zongqiong sun
- Department of Radiology, Affiliated Hospital of Jiangnan University, The Fourth People’s Hospital of Wuxi City, Jiangsu Province, 214062, China
| | - Shudong Hu
- Department of Radiology, Affiliated Hospital of Jiangnan University, The Fourth People’s Hospital of Wuxi City, Jiangsu Province, 214062, China
| | - Jie Li
- Department of Intervention, Affiliated Hospital of Jiangnan University, The Fourth People’s Hospital of Wuxi City, Jiangsu Province, 214062, China
| | - Teng Wang
- Department of Oncology, Affiliated Hospital of Jiangnan University, The Fourth People’s Hospital of Wuxi City, Jiangsu Province, 214062, China
| | - Zhihui Xie
- Department of Surgical Gastroenterology, Affiliated Hospital of Jiangnan University, The Fourth People’s Hospital of Wuxi City, Jiangsu Province, 214062, China
| | - Linfang Jin
- Department of Pathology, Affiliated Hospital of Jiangnan University, The Fourth People’s Hospital of Wuxi City, Jiangsu Province, 214062, China
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Sun Z, Li J, Wang T, Xie Z, Jin L, Hu S. Predicting perigastric lymph node metastasis in gastric cancer with CT perfusion imaging: A prospective analysis. Eur J Radiol 2020; 122:108753. [DOI: 10.1016/j.ejrad.2019.108753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/21/2019] [Accepted: 11/14/2019] [Indexed: 02/07/2023]
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The value of 18F-FDG PET/CT and carbohydrate antigen 19-9 in predicting lymph node micrometastases of pancreatic cancer. Abdom Radiol (NY) 2019; 44:4057-4062. [PMID: 31570958 DOI: 10.1007/s00261-019-02248-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE This study aimed to assess the value of 18F-FDG PET/CT and carbohydrate antigen 19-9 (CA 19-9) levels in predicting lymph node micrometastases in patients with pancreatic cancer. PATIENTS AND METHODS A total of 160 patients with pancreatic carcinoma were included in the study from 2012 to 2017. All patients underwent surgical treatment and PET/CT scans as well as tests to measure CA 19-9 levels before surgery. The PET/CT scans were evaluated by 2 nuclear medicine physicians who were blinded to the clinical information and were compared to the postsurgical pathological findings. Logistic regression analysis was performed to determine the variables that could predict lymph node micrometastases. Receiver operating characteristic (ROC) curves were utilized to find the best cutoff value of the variables related to predicting lymph node micrometastases. RESULTS The maximum standardized uptake value (SUVmax) of the primary tumor and CA 19-9 level were potent predictors for determining the lymph node status. The best SUVmax and CA 19-9 cutoff values for predicting lymph node micrometastases were 7.05 (sensitivity = 71.2%, specificity = 76.6%) and 240.55 U/ml (sensitivity = 62.1%, specificity = 79.8%), respectively. CONCLUSION Patients with pancreatic cancer with a tumor SUVmax ≥ 7.05 or a CA 19-9 value ≥ 240.55 are likely to have lymph node micrometastases.
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