Kim Tae-Hyung, Lim Myong Cheol, Kim Se Ik, Seo Sang-Soo, Kim Sun Ho, Park Sang-Yoon
Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Republic of Korea.
Ann Surg Oncol. 2016 Apr;23(4):1302-8. doi: 10.1245/s10434-015-5015-0. Epub 2015 Dec 29.
The aim of this study was to determine whether the preoperative diameter of cardiophrenic lymph nodes (CPLNs) along the short and long axes, determined via computed tomography (CT), predicts CPLN metastasis in patients with advanced epithelial ovarian cancer.
A total of 31 patients with primary advanced ovarian cancer who had CPLN dissection underwent preoperative CT that was reviewed twice by a radiologist blinded to the final pathology. An array of CT features and clinical factors [age, cancer antigen 125 (CA 125)] were compared between metastasis-positive and metastasis-negative CPLNs using the t test and Fisher's exact test. The optimal CPLN dimensions that best predicted metastasis were calculated using a receiver operating characteristic (ROC) curve, and were applied to find the correlation with other CT findings. Results were validated in an independent test set of nine patients by using the best cutoff value to predict metastasis.
Pathological evaluation revealed metastasis-positive CPLNs in 19 patients and metastasis-negative CPLNs in 12 patients. Metastasis-positive CPLNs had significantly reduced short axes than those of negative CPLNs (5.6 ± 1.7 and 7.8 ± 2.2, respectively; p < 0.001). ROC curve analysis showed that a cutoff value of 7 mm for the short axis demonstrated the largest area under the curve (0.789; p < 0.0007), with 63.16 % sensitivity and 83.33 % specificity. The presence of peritoneal metastasis and abdominopelvic adenopathy strongly related with CPLN adenopathy. Accuracies were 66.7 % (six of nine patients) based on the cutoff value in the independent test set.
The probability of detecting CPLN metastasis in patients with advanced ovarian cancer was approximately 85 % when the short axis of the CPLN was >7 mm in preoperative CT scans. Patients with CPLNs of this size may be candidates for CPLN dissection in order to confirm the pathological diagnosis.
本研究旨在确定通过计算机断层扫描（CT）测定的心脏膈面淋巴结（CPLN）短轴和长轴的术前直径是否可预测晚期上皮性卵巢癌患者的CPLN转移。
共有31例接受CPLN清扫术的原发性晚期卵巢癌患者术前行CT检查，由一位对最终病理结果不知情的放射科医生对CT进行两次评估。使用t检验和Fisher精确检验比较转移阳性和转移阴性CPLN之间的一系列CT特征和临床因素[年龄、癌抗原125（CA 125）]。使用受试者工作特征（ROC）曲线计算最能预测转移的最佳CPLN尺寸，并应用于寻找与其他CT结果的相关性。通过使用预测转移的最佳临界值，在9例患者的独立测试集中验证结果。
病理评估显示19例患者CPLN转移阳性，12例患者CPLN转移阴性。转移阳性的CPLN短轴明显短于转移阴性的CPLN（分别为5.6±1.7和7.8±2.2；p<0.001）。ROC曲线分析显示，短轴临界值为7 mm时曲线下面积最大（0.789；p<0.0007），敏感性为63.16%，特异性为83.33%。腹膜转移和腹盆腔淋巴结肿大与CPLN淋巴结肿大密切相关。基于独立测试集中的临界值，准确率为66.7%（9例患者中的6例）。
术前CT扫描中CPLN短轴>7 mm时，晚期卵巢癌患者检测到CPLN转移的概率约为85%。这种大小的CPLN患者可能是CPLN清扫术的候选者，以确认病理诊断。
