Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan; Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Science, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan; Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan.
Asian J Surg. 2020 Jun;43(6):676-682. doi: 10.1016/j.asjsur.2019.09.001. Epub 2019 Sep 27.
BACKGROUND/OBJECTIVE: Paraaortic lymph node (PALN) metastasis influences treatment strategy for colorectal cancer. The aims of this study were to elucidate the diagnostic value of computed tomography (CT) and positron emission tomography (PET) for PALN metastasis from left-sided colorectal cancer.
A total of 108 patients who underwent radical surgery including PALN dissection were included. Size and morphology of PALN were evaluated using CT, and presence of higher FDG uptake was evaluated using PET. Findings of CT and PET were compared with pathological status.
The largest major axis ≥11 mm and heterogeneous internal density were predictive factors on multivariate analysis. Eighty five percent of the PALNs ≥11 mm with heterogeneous internal density were pathologically metastatic, whereas 94.1% without them were not metastatic. PET had an accuracy, sensitivity, and specificity of 85.7%, 66.7%, and 94.1%, respectively. In patients with PALNs <11 mm without heterogeneous internal density, the accuracy and specificity of PET improved to 93.8% and 96.6%, respectively. Conversely, in patients with some predictive CT findings, although the positive predictive value of PET increased from 83.3% to 88.9%, the accuracy and sensitivity remained at 70.6% and 66.7%, respectively, and 50.0% were false-negatives.
CT had high NPV and relatively high PPV. PET had high specificity but low sensitivity. The addition of PET could be useful to confirm no PALN metastasis in patients with no predictive CT findings. Conversely, the improvement of diagnostic ability was limited in patients with some predictive CT findings.
背景/目的：腹主动脉旁淋巴结（PALN）转移影响结直肠癌的治疗策略。本研究旨在阐明 CT 和正电子发射断层扫描（PET）对左侧结直肠癌 PALN 转移的诊断价值。
共纳入 108 例接受包括 PALN 清扫术在内的根治性手术的患者。使用 CT 评估 PALN 的大小和形态，使用 PET 评估 FDG 摄取的存在情况。将 CT 和 PET 的结果与病理状态进行比较。
最大长轴≥11mm 和不均匀内部密度是多变量分析的预测因素。85%的≥11mm 且不均匀内部密度的 PALN 为病理性转移，而 94.1%无这些特征的 PALN 未转移。PET 的准确性、敏感性和特异性分别为 85.7%、66.7%和 94.1%。在 PALNs＜11mm 且无不均匀内部密度的患者中，PET 的准确性和特异性分别提高至 93.8%和 96.6%。相反，在具有某些预测 CT 发现的患者中，尽管 PET 的阳性预测值从 83.3%增加至 88.9%，但准确性和敏感性仍分别为 70.6%和 66.7%，且 50.0%为假阴性。
CT 具有高的阴性预测值和相对较高的阳性预测值。PET 具有高特异性但敏感性低。在无预测 CT 发现的患者中，添加 PET 有助于确认无 PALN 转移。相反，在具有某些预测 CT 发现的患者中，诊断能力的提高有限。
