CT 诊断黑色素瘤髂腹股沟淋巴结转移：大小和不对称之外的影像学特征。

CT diagnosis of ilioinguinal lymph node metastases in melanoma using radiological characteristics beyond size and asymmetry.

机构信息

Department of Academic Surgery, Sarcoma and Melanoma Unit, The Royal Marsden Hospital, London, UK.

Department of Radiology, The Royal Marsden Hospital, London, UK.

出版信息

BJS Open. 2021 Jan 8;5(1). doi: 10.1093/bjsopen/zraa005.

DOI:10.1093/bjsopen/zraa005

PMID:33609385

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7893466/

Abstract

BACKGROUND

Diagnosis of lymph node (LN) metastasis in melanoma with non-invasive methods is challenging. The aim of this study was to evaluate the diagnostic accuracy of six LN characteristics on CT in detecting melanoma-positive ilioinguinal LN metastases, and to determine whether inguinal LN characteristics can predict pelvic LN involvement.

METHODS

This was a single-centre retrospective study of patients with melanoma LN metastases at a tertiary cancer centre between 2008 and 2016. Patients who had preoperative contrast-enhanced CT assessment and ilioinguinal LN dissection were included. CT scans containing significant artefacts obscuring the pelvis were excluded. CT scans were reanalysed for six LN characteristics (extracapsular spread (ECS), minimum axis (MA), absence of fatty hilum (FH), asymmetrical cortical nodule (CAN), abnormal contrast enhancement (ACE) and rounded morphology (RM)) and compared with postoperative histopathological findings.

RESULTS

A total of 90 patients were included. Median age was 58 (range 23-85) years. Eighty-eight patients (98 per cent) had pathology-positive inguinal disease and, of these, 45 (51 per cent) had concurrent pelvic disease. The most common CT characteristics found in pathology-positive inguinal LNs were MA greater than 10 mm (97 per cent), ACE (80 per cent), ECS (38 per cent) and absence of RM (38 per cent). In multivariable analysis, inguinal LN characteristics on CT indicative of pelvic disease were RM (odds ratio (OR) 3.3, 95 per cent c.i. 1.2 to 8.7) and ECS (OR 4.2, 1.6 to 11.3). Cloquet's node is known to be a poor predictor of pelvic spread. Pelvic LN disease was present in 50 per cent patients, but only 7 per cent had a pathology-positive Cloquet's node.

CONCLUSION

Additional CT radiological characteristics, especially ECS and RM, may improve diagnostic accuracy and aid clinical decisions regarding the need for inguinal or ilioinguinal dissection.

摘要

背景

使用非侵入性方法诊断黑色素瘤的淋巴结（LN）转移具有挑战性。本研究旨在评估 CT 上六个 LN 特征在检测黑色素瘤阳性腹股沟 LN 转移中的诊断准确性，并确定腹股沟 LN 特征是否可以预测盆腔 LN 受累。

方法

这是一项单中心回顾性研究，纳入了 2008 年至 2016 年期间在一家三级癌症中心接受黑色素瘤 LN 转移手术的患者。纳入标准为患者术前接受了增强 CT 评估和腹股沟 LN 清扫术，排除了 CT 扫描中存在明显干扰骨盆的伪影的患者。对 CT 扫描进行了重新分析，以评估六个 LN 特征（包膜外扩散（ECS）、最小轴（MA）、无脂肪门（FH）、不对称皮质结节（CAN）、异常对比增强（ACE）和圆形形态（RM）），并与术后组织病理学发现进行比较。

结果

共纳入 90 例患者，中位年龄为 58 岁（范围 23-85 岁）。88 例患者（98%）腹股沟疾病为阳性，其中 45 例（51%）同时存在盆腔疾病。在阳性腹股沟 LN 中，最常见的 CT 特征是 MA 大于 10mm（97%）、ACE（80%）、ECS（38%）和 RM 缺失（38%）。多变量分析显示，CT 上提示盆腔疾病的腹股沟 LN 特征是 RM（优势比（OR）3.3，95%置信区间（CI）1.2 至 8.7）和 ECS（OR 4.2，1.6 至 11.3）。已知 Cloquet 淋巴结是盆腔转移的不良预测因子。50%的患者存在盆腔 LN 疾病，但仅有 7%的 Cloquet 淋巴结为阳性。