Colorectal Research, Pelican Cancer Foundation, Basingstoke, UK.
Br J Surg. 2010 Sep;97(9):1431-6. doi: 10.1002/bjs.7116.
In rectal cancer the management of suspicious magnetic resonance imaging (MRI)-detected lymph nodes lying close to the mesorectal fascia poses an ongoing dilemma. Key decisions in treatment planning are commonly based on the prediction of margin status. However, it is unclear whether a lymph node that appears to contain tumour close to the mesorectal fascia will result in a positive margin.
Some 396 patients with rectal cancer were included. MRI assessment of mesorectal nodes, the pathologically involved circumferential resection margin (CRM) rate and causes of margin involvement were analysed to establish the clinical significance of MRI-detected suspicious lymph nodes at the resection margin.
Fifty (12.6 per cent) of 396 patients had a positive CRM on histopathological analysis, five (10 per cent) solely due to an involved lymph node. Four of the five malignant nodes were not predicted on MRI. Thirty-one of the 396 MRI studies had suspicious nodes 1 mm or less from the CRM. None of these patients had a positive CRM owing to nodal involvement.
Involvement of the CRM by lymph node metastases alone is uncommon.
在直肠癌中，靠近直肠系膜筋膜的可疑磁共振成像（MRI）检测到的淋巴结的处理是一个持续存在的难题。治疗计划中的关键决策通常基于对边缘状态的预测。然而，尚不清楚靠近直肠系膜筋膜的似乎包含肿瘤的淋巴结是否会导致阳性边缘。
共纳入 396 例直肠癌患者。对直肠系膜淋巴结进行 MRI 评估，分析病理累及的环周切缘（CRM）率和边缘受累的原因，以确定切除缘 MRI 检测到的可疑淋巴结的临床意义。
50 例（12.6%）患者的 CRM 在组织病理学分析中为阳性，5 例（10%）仅因淋巴结受累。5 个恶性淋巴结中有 4 个在 MRI 上未被预测到。396 例 MRI 研究中有 31 例可疑淋巴结距 CRM 为 1 毫米或更短。这些患者无一因淋巴结受累而出现 CRM 阳性。
单独由淋巴结转移累及 CRM 的情况并不常见。
