Wang Yizhe, Yao Jingjing, Wang Liang, Zheng Zhuozhao, Zhang Chen, Li Jie
Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China.
Department of Pathology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China.
J Gastrointest Oncol. 2025 Jun 30;16(3):1258-1267. doi: 10.21037/jgo-2024-1017. Epub 2025 Jun 19.
Lymph node (LN) metastasis is one of the significant prognostic factors after pancreaticoduodenectomy (PD) for distal cholangiocarcinoma (DCC). Upper abdominal enhanced computed tomography (CT) scan is a routine examination for patients with DCC; however, the predicted value of its imaging features for LN metastasis has not been sufficiently assessed. Furthermore, there is a lack of widely accepted standards in imaging features that can accurately predict LN metastasis and early recurrence (ER). This study aimed to investigate the values of regional LNs imaging features in predicting LN metastasis and ER in patients with DCC.
All patients who underwent PD for DCC in Beijing Tsinghua Changgung Hospital were retrospectively identified. Their clinical documentation, pathological results, and imaging features of regional LNs on preoperative abdominal enhanced CT images were reviewed.
Of 61 DCC patients, 19 (31.1%) experienced ER. Patients who experienced ER had significantly higher percentage of pancreatic invasion, and peri-pancreas LN metastasis than patients who did not (P=0.045 and 0.03, respectively). Patients who had peri-pancreas LN metastasis showed significantly higher percentages in the following imaging features: at least 1 LN with short-axis diameter ≥10 mm, at least 2 LNs with short-axis diameter ≥8 mm, and at least 3 LNs with short-axis diameter ≥6 mm than patients who did not (P=0.04, 0.02, and 0.003, respectively). Among these imaging features, at least 3 LNs with short-axis diameter ≥6 mm (P=0.03) was found to be independent ones to predict peri-pancreatic LN metastasis. Moreover, the imaging feature of at least 3 LNs with short-axis diameter ≥6 mm had better performance on predicting LN metastasis in sensitivity (50.0%), specificity (85.4%), positive predictive value (62.5%), negative predictive value (77.8%), and accuracy (73.8%) than the commonly used diagnosing criteria for LN metastasis of at least 1 LN with short-axis diameter ≥10 mm or central necrosis in LN.
The imaging feature of at least 3 LNs with short-axis diameter ≥6 mm could predict LN metastasis with high specificity, and provide a clue for predicting ER after PD in patients with DCC.
淋巴结（LN）转移是远端胆管癌（DCC）胰十二指肠切除术（PD）后重要的预后因素之一。上腹部增强计算机断层扫描（CT）是DCC患者的常规检查；然而，其影像学特征对LN转移的预测价值尚未得到充分评估。此外，在能够准确预测LN转移和早期复发（ER）的影像学特征方面缺乏广泛接受的标准。本研究旨在探讨DCC患者区域LN影像学特征在预测LN转移和ER中的价值。
回顾性纳入在北京清华长庚医院接受DCC根治性手术切除的患者。收集患者的临床资料、病理结果及术前腹部增强CT图像上区域LN的影像学特征。
61例DCC患者中，19例（31.1%）发生ER。发生ER的患者胰腺侵犯及胰周LN转移比例显著高于未发生ER的患者（分别为P = 0.045和0.03）。有胰周LN转移的患者在以下影像学特征上的比例显著高于无转移的患者：至少1个短轴直径≥10 mm的LN、至少2个短轴直径≥8 mm的LN、至少3个短轴直径≥6 mm的LN（分别为P = 0.04、0.02和0.003）。在这些影像学特征中，至少3个短轴直径≥6 mm的LN（P = 0.03）被发现是预测胰周LN转移的独立因素。此外，至少3个短轴直径≥6 mm的LN影像学特征在预测LN转移方面，其敏感性（50.0%）、特异性（85.4%）、阳性预测值（62.5%）、阴性预测值（77.8%）和准确性（73.8%）均优于常用的至少1个短轴直径≥10 mm或LN中央坏死的LN转移诊断标准。
至少3个短轴直径≥6 mm的LN影像学特征能够以较高的特异性预测LN转移，并为DCC患者PD术后预测ER提供线索。
