Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
World J Surg Oncol. 2017 Sep 20;15(1):176. doi: 10.1186/s12957-017-1246-9.
Treatment planning especially liver resection in cholangiocarcinoma (CCA) depends on the extension of tumor and lymph node metastasis which is included as a key criterion for operability. Magnetic resonance imaging (MRI) offers a rapid and powerful tool for the detection of lymph node metastasis (LNM) and in the current manuscript is assessed as a critical tool in the preoperative protocol for liver resection for treatment of CCA. However, the accuracy of MRI to detect LNM from CCA had yet to be comprehensively evaluated.
The accuracy of MRI to detect LNM was assessed in a cohort of individuals with CCA from the Cholangiocarcinoma Screening and Care Program (CASCAP), a screening program designed to reduce CCA in Northeastern Thailand by community-based ultrasound (US) for CCA. CCA-positive individuals are referred to one of the nine tertiary centers in the study to undergo a preoperative protocol that included enhanced imaging by MRI. Additionally, these individuals also underwent lymph node biopsies for histological confirmation of LNM (the "gold standard") to determine the accuracy of the MRI results.
MRI accurately detected the presence or absence of LNM in only 29 out of the 51 CCA cases (56.9%, 95% CI 42.2-70.7), resulting in a sensitivity of 57.1% (95% CI 34.0-78.2) and specificity of 56.7% (95% CI 37.4-74.5), with positive and negative predictive values of 48.0% (95% CI 27.8-68.7) and 65.4% (95% CI 44.3-82.8), respectively. The positive likelihood ratio was 1.32 (95% CI 0.76-2.29), and the negative likelihood ratio was 0.76 (95% CI 0.42-1.36).
MRI showed limited sensitivity and a poor positive predictive value for the diagnosis of LNM for CCA, which is of particular concern in this resource-limited setting, where simpler detection methods could be utilized that are more cost-effective in this region of Thailand. Therefore, the inclusion of MRI, a costly imaging method, should be reconsidered as part of protocol for treatment planning of CCA, given the number of false positives, especially as it is critical in determining the operability for CCA subjects.
胆管癌（CCA）的治疗计划，特别是肝切除术，取决于肿瘤的范围和淋巴结转移，这是可手术性的关键标准之一。磁共振成像（MRI）为淋巴结转移（LNM）的检测提供了一种快速而强大的工具，在本研究中，它被评估为治疗 CCA 的肝切除术术前方案中的关键工具。然而，MRI 检测 CCA 中 LNM 的准确性尚未得到全面评估。
我们在胆管癌筛查和护理计划（CASCAP）的 CCA 患者队列中评估了 MRI 检测 LNM 的准确性，该筛查计划旨在通过社区为基础的超声（US）筛查减少泰国东北部的 CCA。CCA 阳性的患者被转诊到研究中的九个三级中心之一，接受术前方案，包括 MRI 增强成像。此外，这些患者还进行了淋巴结活检，以进行组织学确认 LNM（“金标准”），以确定 MRI 结果的准确性。
MRI 仅在 51 例 CCA 病例中的 29 例（56.9%，95%置信区间 42.2-70.7）中准确检测到 LNM 的存在或不存在，其敏感性为 57.1%（95%置信区间 34.0-78.2），特异性为 56.7%（95%置信区间 37.4-74.5），阳性预测值为 48.0%（95%置信区间 27.8-68.7）和阴性预测值为 65.4%（95%置信区间 44.3-82.8）。阳性似然比为 1.32（95%置信区间 0.76-2.29），阴性似然比为 0.76（95%置信区间 0.42-1.36）。
MRI 对 CCA 中 LNM 的诊断显示出有限的敏感性和较差的阳性预测值，这在资源有限的情况下尤其令人关注，在泰国的这个地区，可能需要利用更经济有效的简单检测方法。因此，鉴于假阳性数量较多，MRI 作为一种昂贵的成像方法，其作为 CCA 治疗计划方案一部分的纳入应重新考虑，特别是因为它对确定 CCA 患者的可操作性至关重要。
