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Preoperative assessment of para-aortic lymph node metastasis in patients with pancreatic cancer

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Abstract

Background

Para-aortic lymph node (PALN) metastasis is an important prognostic factor in patients with pancreatic cancer, but accurate preoperative diagnosis is difficult. The objective of this study was to assess the accuracy of diagnosis of PALN by computed tomography (CT), magnetic resonance imaging (MRI), and 18F-fluorodeoxyglucose positron-emission tomography (FDG-PET).

Methods

From August 2005 to July 2008, 119 patients with invasive ductal adenocarcinoma of the pancreas were included in this study. PALNs with a longer diameter >10 mm on CT or MRI were suspected of being involved by metastasis, whereas FDG uptake exceeding that of the adjacent normal tissue was considered to be positive for metastasis on FDG-PET studies. The imaging findings were compared with the pathological diagnosis of PALN metastasis.

Results

PALN dissection was performed in 71 patients (60.0%). Although histopathological examination revealed metastasis in 6 patients (8.5%), none of these patients was positive in any of the preoperative imaging studies. The longer diameter, the shorter diameter, the ratio of the two diameters, and the calculated lymph node volume showed no significant differences between patients with and without PALN metastasis.

Conclusions

Preoperative detection of PALN metastasis in patients with pancreatic cancer is very difficult. Intraoperative histopathological examination of frozen sections is necessary if radical resection is contemplated.

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References

  1. Matsuno S, Egawa S, Fukuyama S et al (2004) Pancreatic Cancer Registry in Japan: 20 years of experience. Pancreas 28:219–230

    Article  PubMed  Google Scholar 

  2. Herrmann R, Jelic S (2008) Pancreatic cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 19(Suppl 2):ii25–ii26

    Article  PubMed  Google Scholar 

  3. Riall TS, Cameron JL, Lillemoe KD et al (2005) Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma–part 3: update on 5-year survival. J Gastrointest Surg 9:1191–1204 (discussion 204–206)

    Article  PubMed  Google Scholar 

  4. Doi R, Kami K, Ito D et al (2007) Prognostic implication of para-aortic lymph node metastasis in resectable pancreatic cancer. World J Surg 31:147–154

    Article  PubMed  Google Scholar 

  5. Kayahara M, Nagakawa T, Ohta T et al (1999) Analysis of paraaortic lymph node involvement in pancreatic carcinoma: a significant indication for surgery? Cancer 85:583–590

    Article  CAS  PubMed  Google Scholar 

  6. Schwarz M, Pauls S, Sokiranski R et al (2001) Is a preoperative multidiagnostic approach to predict surgical resectability of periampullary tumors still effective? Am J Surg 182:243–249

    Article  CAS  PubMed  Google Scholar 

  7. Soriano A, Castells A, Ayuso C et al (2004) Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography. Am J Gastroenterol 99:492–501

    Article  PubMed  Google Scholar 

  8. Parsons CM, Sutcliffe JL, Bold RJ (2008) Preoperative evaluation of pancreatic adenocarcinoma. J Hepatobiliary Pancreat Surg 15:429–435

    Article  PubMed  Google Scholar 

  9. Japan Pancreas Society (2003) Classification of pancreatic carcinoma, 2nd English edn. Kanehara & Co., Tokyo

    Google Scholar 

  10. Sobin LH, Wittekind C (2002) TNM classification of malignant tumours, 6th edn. Wiley, New York

    Google Scholar 

  11. Committee on Classification of Regional Lymph Nodes of Japan Society of Clinical Oncology (2003) Classification of regional lymph nodes in Japan. Int J Clin Oncol 8:248–275

    Article  Google Scholar 

  12. Yoshida T, Matsumoto T, Sasaki A et al (2004) Outcome of paraaortic node-positive pancreatic head and bile duct adenocarcinoma. Am J Surg 187:736–740

    Article  PubMed  Google Scholar 

  13. Shimada K, Sakamoto Y, Sano T et al (2006) The role of paraaortic lymph node involvement on early recurrence and survival after macroscopic curative resection with extended lymphadenectomy for pancreatic carcinoma. J Am Coll Surg 203:345–352

    Article  PubMed  Google Scholar 

  14. de Bondt RB, Nelemans PJ, Hofman PA et al (2007) Detection of lymph node metastases in head and neck cancer: a meta-analysis comparing US, USgFNAC, CT and MR imaging. Eur J Radiol 64:266–272

    Article  PubMed  Google Scholar 

  15. Hovels AM, Heesakkers RA, Adang EM et al (2008) The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol 63:387–395

    Article  CAS  PubMed  Google Scholar 

  16. Karmazanovsky G, Fedorov V, Kubyshkin V et al (2005) Pancreatic head cancer: accuracy of CT in determination of resectability. Abdom Imaging 30:488–500

    Article  CAS  PubMed  Google Scholar 

  17. Roche CJ, Hughes ML, Garvey CJ et al (2003) CT and pathologic assessment of prospective nodal staging in patients with ductal adenocarcinoma of the head of the pancreas. Am J Roentgenol 180:475–480

    Google Scholar 

  18. Seo S, Doi R, Machimoto T et al (2008) Contribution of 18F-fluorodeoxyglucose positron-emission tomography to the diagnosis of early pancreatic carcinoma. J Hepatobiliary Pancreat Surg 15:634–639

    Article  PubMed  Google Scholar 

  19. Rose DM, Delbeke D, Beauchamp RD et al (1999) 18Fluorodeoxyglucose-positron-emission tomography in the management of patients with suspected pancreatic cancer. Ann Surg 229:729–737 (discussion 37–38)

    Article  CAS  PubMed  Google Scholar 

  20. Berberat P, Friess H, Kashiwagi M et al (1999) Diagnosis and staging of pancreatic cancer by positron-emission tomography. World J Surg 23:882–887

    Article  CAS  PubMed  Google Scholar 

  21. Sperti C, Pasquali C, Chierichetti F et al (2001) Value of 18-fluorodeoxyglucose positron-emission tomography in the management of patients with cystic tumors of the pancreas. Ann Surg 234:675–680

    Article  CAS  PubMed  Google Scholar 

  22. Imdahl A, Nitzsche E, Krautmann F et al (1999) Evaluation of positron-emission tomography with 2-[18F]fluoro-2-deoxy-d-glucose for the differentiation of chronic pancreatitis and pancreatic cancer. Br J Surg 86:194–199

    Article  CAS  PubMed  Google Scholar 

  23. Golder WA (2004) Lymph node diagnosis in oncologic imaging: a dilemma still waiting to be solved. Onkologie 27:194–199

    Article  CAS  PubMed  Google Scholar 

  24. Wunderbaldinger P (2006) Problems and prospects of modern lymph node imaging. Eur J Radiol 58:325–337

    Article  PubMed  Google Scholar 

  25. Bares R, Dohmen BM, Cremerius U et al (1996) Results of positron-emission tomography with fluorine-18 labeled fluorodeoxyglucose in differential diagnosis and staging of pancreatic carcinoma. Radiologe 36:435–440

    Article  CAS  PubMed  Google Scholar 

  26. Bares R, Klever P, Hauptmann S et al (1994) F-18 fluorodeoxyglucose PET in vivo evaluation of pancreatic glucose metabolism for detection of pancreatic cancer. Radiology 192:79–86

    CAS  PubMed  Google Scholar 

  27. Diederichs CG, Staib L, Vogel J et al (2000) Values and limitations of 18F-fluorodeoxyglucose-positron-emission tomography with preoperative evaluation of patients with pancreatic masses. Pancreas 20:109–116

    Article  CAS  PubMed  Google Scholar 

  28. Pakzad F, Groves AM, Ell PJ (2006) The role of positron-emission tomography in the management of pancreatic cancer. Semin Nucl Med 36:248–256

    Article  PubMed  Google Scholar 

  29. Kim JK, Kim KA, Park BW et al (2008) Feasibility of diffusion-weighted imaging in the differentiation of metastatic from nonmetastatic lymph nodes: early experience. J Magn Reson Imaging 28:714–719

    Article  PubMed  Google Scholar 

  30. Holzapfel K, Duetsch S, Fauser C et al (2008) Value of diffusion-weighted MR imaging in the differentiation between benign and malignant cervical lymph nodes. Eur J Radiol 2008 (online first)

  31. Saokar A, Braschi M, Harisinghani M (2006) Lymphotrophic nanoparticle enhanced MR imaging (LNMRI) for lymph node imaging. Abdom Imaging 31:660–667

    Article  CAS  PubMed  Google Scholar 

  32. Heesakkers RA, Hovels AM, Jager GJ et al (2008) MRI with a lymph-node-specific contrast agent as an alternative to CT scan and lymph-node dissection in patients with prostate cancer: a prospective multicohort study. Lancet Oncol 9:850–856

    Article  CAS  PubMed  Google Scholar 

  33. Veit P, Ruehm S, Kuehl H et al (2006) Lymph node staging with dual-modality PET/CT: enhancing the diagnostic accuracy in oncology. Eur J Radiol 58:383–389

    Article  PubMed  Google Scholar 

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Conflict of interest statement

No author has any conflict of interest.

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Authors and Affiliations

  1. Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University, 54 Shogoinkawaracho, Sakyoku, Kyoto, 606-8507, Japan

    Hisashi Imai, Ryuichiro Doi, Hiroyuki Kanazawa, Naoko Kamo, Masayuki Koizumi, Toshihiko Masui, Yasuhiro Iwanaga, Yoshiya Kawaguchi, Yasutsugu Takada & Shinji Uemoto

  2. Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan

    Hiroyoshi Isoda

Authors
  1. Hisashi Imai
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  2. Ryuichiro Doi
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Correspondence to Ryuichiro Doi.

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Imai, H., Doi, R., Kanazawa, H. et al. Preoperative assessment of para-aortic lymph node metastasis in patients with pancreatic cancer. Int J Clin Oncol 15, 294–300 (2010). https://doi.org/10.1007/s10147-010-0066-5

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  • DOI: https://doi.org/10.1007/s10147-010-0066-5

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