Journal of Gastroenterology

, Volume 40, Issue 7, pp 739–743

CT evaluation of paraaortic lymph node metastasis in patients with biliary cancer

  • Takehiro Noji
  • Satoshi Kondo
  • Satoshi Hirano
  • Eiichi Tanaka
  • Yoshiyasu Ambo
  • Yo Kawarada
  • Toshiaki Morikawa
Article

DOI: 10.1007/s00535-005-1618-8

Cite this article as:
Noji, T., Kondo, S., Hirano, S. et al. J Gastroenterol (2005) 40: 739. doi:10.1007/s00535-005-1618-8

Abstract

Background

The extent of paraaortic lymph node (PAN) metastasis parellels that of distant metastases in patients with biliary carcinoma. Accurate preoperative assessment of PAN metastasis has a crucial impact on surgical indications. In this retrospective study, we evaluated whether computed tomography (CT) scans were useful for diagnosing PAN metastases and excluding patients with PAN metastases from an indication for surgery.

Methods

Between March 1999 and November 2003, 57 patients with biliary carcinoma underwent radical lymphadenectomy or surgical biopsy of PANs. Nine of these patients were diagnosed as having PAN metastasis microscopically. All patients had undergone abdominal CT scans before surgery. To diagnose PAN metastases, we used the following diagnostic criteria. (1) Size; when lymph nodes were greater than 12 mm, 10 mm, 8 mm, or 6 mm in longo or short-axis diameter, the nodes were considered metastatic. (2) Shape and size; when the axial ratio of a lymph node was greater than 0.5, 0.7, 1.0, and the maximum diameter of the long or short axis was greater than 12 mm, 10 mm, 8 mm, or 6 mm, the node was considered metastatic. (3) Internal structure; if the internal structure of a PAN was heterogeneous, the node was considered metastatic. A positive predictive value was calculated for each included criterion when patients numbered ten or more.

Results

Positive predictive values using the above criteria ranged from 13% to 36%. Only one patient had PANs with heterogeneous internal structures.

Conclusions

We were unable to determine surgical indications based on the morphological criteria revealed by a CT scan.

Key words

computed tomography biliary carcinoma paraaortic lymph nodes 

Copyright information

© Springer-Verlag Tokyo 2005

Authors and Affiliations

  • Takehiro Noji
    • 1
  • Satoshi Kondo
    • 1
  • Satoshi Hirano
    • 1
  • Eiichi Tanaka
    • 1
  • Yoshiyasu Ambo
    • 1
  • Yo Kawarada
    • 1
  • Toshiaki Morikawa
    • 1
  1. 1.Department of Surgical OncologyHokkaido University Graduate School of MedicineSapporoJapan

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