RA09.01: NORMAL LYMPH NODE APPEARANCE IN THE THORAX

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 39-40
Author(s):  
Tomas Hansen ◽  
Magnus Nilsson ◽  
Daniel Lindholm ◽  
Johan Sundström ◽  
Jakob Hedberg
Keyword(s):  
Computed Tomography ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Conflicts Of Interest ◽  
Clinical Stage ◽  
Diagnostic Assessment ◽  
Clinical Staging ◽  
Short Axis ◽  
Nodal Stage

Abstract Background Modern treatment of esophageal cancer is multimodal and highly dependent on detailed diagnostic assessment of clinical stage which includes nodal stage. Clinical appraisal of nodal stage requires knowledge of normal radiological appearance, information of which is scarce. We aimed to describe lymph node appearance on computed tomography (CT) investigations in a randomly selected cohort of healthy subjects. Methods In a sample of 426 healthy Swedish volunteers aged 50–64 years, CT scans were studied in detail concerning intrathoracic node stations relevant in clinical staging of esophageal cancer. With stratification for sex, the short axis of visible lymph nodes was measured and distribution of lymph node sizes was calculated as well as proportion of patients with visible nodes above 5 and 10 millimeters for each station. Probability of having any lymph node station above 5 and 10 millimeters was calculated with a logistic regression model adjusted for age and sex. Results In the 214 men (age 57.3 ± 4.1 years) and 212 women (57.8 ± 4.4years) included in the study, a total of 309 (72.5%) had a lymph node with a short axis of 5 mm or above was seen in one of the node stations investigated. When using 10 mm as a cutoff, nodes were visible in 29 (6.81%) patients. Men had three times higher odds of having any lymph node with short axis 5 mm or above (OR 3.03 95% CI 1.89–4.85, P < 0.001) as well as 10mm or above (OR 2.31 95% CI 1.02–5.23, P = 0.044) compared to women. Higher age was not associated with propensity for lymph nodes above 5 or 10 millimeters in this sample. Conclusion In a randomly selected cohort of patients between 50 and 64 years, almost ten percent of the men and four percent of the women had lymph nodes above ten millimeters, most frequently in the subcarinal station (station 107). More than half of the patients had nodes above five millimeters on computed tomography and men were much more prone to have this finding. The probability of finding lymph nodes in specific stations relevant of esophageal cancer is now described. Disclosure All authors have declared no conflicts of interest.

Normal radiological lymph node appearance in the thorax

2018 ◽  
Vol 32 (10) ◽  
pp. 1-6 ◽  
Author(s):  
T Hansen ◽  
M Nilsson ◽  
D Lindholm ◽  
J Sundström ◽  
J Hedberg
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Healthy Subjects ◽  
Clinical Stage ◽  
Diagnostic Assessment ◽  
Clinical Staging ◽  
Short Axis ◽  
Swedish Population ◽  
Nodal Stage

SUMMARY Modern treatment of esophageal cancer is multimodal and highly dependent on a detailed diagnostic assessment of clinical stage, which includes nodal stage. Clinical appraisal of nodal stage is highly dependent on knowledge of normal radiological appearance, information of which is scarce. We aimed to describe lymph node appearance on computed tomography (CT) investigations in a randomly selected cohort of healthy subjects. In a sample of the Swedish Cardiopulmonary bioimage study, which investigates a sample of the Swedish population aged 50–64 years, the CT scans of 426 subjects were studied in detail concerning intrathoracic node stations relevant in clinical staging of esophageal cancer. With stratification for sex, the short axis of visible lymph nodes was measured and the distribution of lymph node sizes was calculated as well as proportion of patients with visible nodes above 5 and 10 millimeters for each station. Probability of having any lymph node station above 5 and 10 millimeters was calculated with a logistic regression model adjusted for age and sex. In the 214 men (aged: 57.3 ± 4.1 years) and 212 women (aged: 57.8 ± 4.4 years) included in this study, a total of 309 (72.5%) had a lymph node with a short axis of 5 mm or above was seen in at least one of the node stations investigated. When using 10 mm as a cutoff, nodes were visible in 29 (6.81%) of the subjects. Men had higher odds of having any lymph node with short axis 5 mm or above (OR 3.03 95% CI 1.89–4.85, P &lt; 0.001) as well as 10 mm or above (OR 2.31 95% CI 1.02–5.23, P = 0.044) compared to women. Higher age was not associated with propensity for lymph nodes above 5 or 10 millimeters in this sample. We conclude that, in a randomly selected cohort of patients between 50 and 64 years, almost 10% of the men and 4% of the women had lymph nodes above 10 millimeters, most frequently in the subcarinal station (station 107). More than half of the patients had nodes above 5 millimeters on CT and men were much more prone to have this finding. The probability of finding lymph nodes in specific stations relevant of esophageal cancer is now described.

VS01.04: RELIABLE SURGICAL TECHNIQUES FOR LYMPHADENECTOMY ALONG THE LEFT RECURRENT LARYNGEAL NERVE DURING THORACOSCOPIC ESOPHAGECTOMY IN THE PRONE POSITION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 44-44
Author(s):  
Taro Oshikiri ◽  
Tetsu Nakamura ◽  
Hiroshi Hasegawa ◽  
Masashi Yamamoto ◽  
Shingo Kanaji ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Recurrent Laryngeal Nerve ◽  
Prone Position ◽  
Conflicts Of Interest ◽  
Surgical Techniques ◽  
Laryngeal Nerve ◽  
Thoracoscopic Esophagectomy ◽  
Left Recurrent Laryngeal Nerve

Abstract Description Background Lymphadenectomy along the left recurrent laryngeal nerve (RLN) in esophageal cancer is important for disease control but requires advanced dissection skills. Complete dissection of the lymph nodes along the left RLN in a safe manner is important. We demonstrate the reliable method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the prone position (TEP). Methods This procedure is performed for all of resectable thoracic esophageal cancers. The essence of this method is to recognize the lateral pedicle as a two-dimensional membrane that inclu replicatedes the left RLN, lymph nodes around the nerve, and primary esophageal arteries. By drawing the proximal portion of the divided esophagus and the lateral pedicle, identification and reliable cutting of the primary esophageal arteries and distinguishing the left RLN from the lymph nodes are simplified. Results We performed 46 TEPs for esophageal cancer using this method with no conversion to an open procedure in 2015 at Kobe University. No intraoperative morbidity related to the left RLN was observed. The mean number of harvested lymph nodes along the left RLN was 6.9 ± 4.2. Left RLN palsy greater than Clavien-Dindo classification grade II occurred in 4 patients (8%), all of them were reversible. The incidence of lymph node metastasis along the left RLN was 22%. Conclusion Our method for lymphadenectomy along the left RLN during TEP is safe and reliable. It has a low incidence of left RLN palsy and provides sufficient lymph node dissection along the left RLN. Disclosure All authors have declared no conflicts of interest.

Computed Tomographic Evaluation of Presumptively Normal Canine Sternal Lymph Nodes

2016 ◽  
Vol 52 (6) ◽  
pp. 371-377 ◽  
Author(s):  
Ryota Iwasaki ◽  
Takashi Mori ◽  
Yusuke Ito ◽  
Mifumi Kawabe ◽  
Mami Murakmi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Body Weight ◽  
Lymph Node ◽  
Retrospective Study ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Prediction Interval ◽  
Short Axis ◽  
Computed Tomographic ◽  
The Mean

ABSTRACT The sternal lymph nodes receive drainage from a wide variety of structures in the thoraco-abdominal region. Evaluation of these lymph nodes is essential, especially in cancer patients. Computed tomography (CT) can detect sternal lymph nodes more accurately than radiography or ultrasonography, and the criteria of the sternal lymphadenopathy are unknown. The purpose of this retrospective study was to describe the CT characteristics of the sternal lymph nodes in dogs considered unlikely to have lymphadenopathy. The ratio of the short axis dimension of the sternal lymph nodes to the thickness of the second sternebra was also investigated. At least one sternal lymph node was identified in each of the 152 dogs included in the study. The mean long axis and short axis dimensions were 0.700 cm and 0.368 cm, respectively. The mean ratio of the sternal lymph nodes to the second sternebrae was 0.457, and the 95% prediction interval ranged from 0.317 to 0.596 (almost a fixed value independent of body weight). These findings will be useful when evaluating sternal lymphadenopathy using CT.

PS02.031: DEFINITIVE CHEMORADIOTHERAPY WITH DOCETAXEL, CISPLATIN, AND 5-FLUOROURACIL (DCF-R) FOR ADVANCED CERVICAL ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 128-129
Author(s):  
Hiroshi Okamoto ◽  
Yusuke Taniyama ◽  
Tadashi Sakurai ◽  
Takahiro Heishi ◽  
Chiaki Sato ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Survival Rate ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Conflicts Of Interest ◽  
Clinical Stage ◽  
Stage Ii ◽  
Definitive Chemoradiotherapy

Abstract Background Recently, definitive chemoradiotherapy (dCRT) has become one of the essential treatment strategies for esophageal squamous cell carcinoma (ESCC) and has been especially gaining prevalence for cervical ESCC to preserve the larynx. There have been recent reports on favorable outcomes of docetaxel/CDDP/5-FU (DCF-R) for advanced esophageal cancer. Our department recently introduced DCF-R for treating advanced cervical ESCC. We analyzed the safety and outcomes of DCF-R in patients with advanced cervical ESCC. Methods We retrospectively evaluated 12 advanced cervical ESCC patients (clinical stage II–IV, including T4b and/or M1 lymph node) in our department who received DCF-R as the first-line treatment between December 2010 and February 2015. Results Our patient cohort comprised 9 males and 3 females (median age, 67.5 years; range: 54–76 years). All patients were squamous cell carcinoma. The median observation period was 34.5 (8–80) months with total irradiation dose of 64.0 (60–70) Gy. The pretreatment clinical stage (according to Union for International Cancer Center) included one stage II, seven stage III, and four stage IV cases (including 3 patients with T4b [2 trachea and 1 thyroid] and 4 patients with M1 lymph node. We attained complete response (CR) in 10 patients and stable disease in 2 patients. Of 10 patients with CR, 5 experienced recurrence and 5 continued exhibiting CR. Two persistent patients included one patient who died of cancer and one patient who underwent salvage surgery. Furthermore, grade 3 or more adverse events as defined in Common Terminology Criteria for Adverse Event version 4 included leucopenia (91.7%), neutropenia (91.7%), febrile neutropenia (50%), and pharyngeal pain (50%). There was no treatment-related mortality and treatment schedules were completed in all patients, although dose reduction of the second cycle of chemotherapy was required in four patients (33%) and change in the radiation schedule was required in one patient (8.3%). While the 2-/3-/5-year overall survival rate was 66.7%/48.6%/48.6%, the 2-/3-/5-year recurrent-free survival rate was 58.3%/50.0%/37.5%, respectively. Conclusion DCF-R treatment for advanced cervical ESCC could be completed by the careful administration, and although a strong blood toxicity might occur, a favorable prognosis can be obtained with larynx preservation. Disclosure All authors have declared no conflicts of interest.

Utility of PET-CT CMR after neoadjuvant chemotherapy with DCF for esophageal cancer as a predictive factor of recurrence.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 434-434
Author(s):  
Suzuki Kosuke ◽  
Shibata Tomotaka ◽  
Nishiki Kohei ◽  
Fumoto Shoichi ◽  
Hirarsuka Takahiro ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Neoadjuvant Chemotherapy ◽  
Lymph Nodes ◽  
Accumulation Rate ◽  
Clinical Stage ◽  
Operation Time ◽  
Regional Lymph Nodes ◽  
Pet Ct ◽  
Significant Difference

434 Background: PET-CT is considered as standard modality for evaluating metastasis of esophageal cancer before treatment. On the other hand, it is unclear whether PET-CT CMR (complete metabolic response) could be useful for assessment after neoadjuvant chemotherapy. To clarify the utility of PET-CT CMR as an adequate modality of prediction for recurrence after neoadjuvant chemotherapy with DCF for esophageal cancer. Methods: Fifty-eight cases of esophageal cancer (cStageII-IVa) who received the esophagectomy with neoadjuvant chemotherapy of DCF since June 2013 in Oita University. We evaluated the clinicopathological factors, RFS and OS between CMR group (n=22, 38%) and non-CMR group (n=36, 62%). Results: In the clinical stage before chemotherapy, T-factor was higher in the non-CMR group (p = 0.044), but there were no significant differences of lymph node metastasis (p = 0.27) and stage (p = 0.94) between the two groups. There was no significant difference of the SUV max (16.4 ± 6.5 vs 15.7 ± 6.5, p = 0.98) of the main lesion before chemotherapy and the FDG accumulation rate of lymph nodes (14 cases (63.6%) vs 21 cases) (58.3%), p = 0.69) between the two groups. There were no significant differences of the surgical procedure, lymph node dissection area, number of harvested lymph nodes, amount of bleeding, operation time, curability, and intra/post-operative complications between the two groups. There were 5 cases (15%) with postoperative recurrence in the CMR group (lung 1 case, extra-regional lymph nodes 3 cases, bone 1 case), 17 cases (47%) in the non-CMR group (local 4 cases, lung 3 cases, livers 5 cases, extra regional lymph nodes 6 cases, bone 4 cases, pleura 2 cases), but there was no significant difference between the two groups (p = 0.062). There were significant differences between the two groups for 3-year RFS (81.3 vs 65.3 months, p=0.021) and 3-year OS (93.8 vs 61.6 months, p=0.011). Conclusions: PET-CR CMR could not predict recurrence at present. PET-CR CMR cases had better prognosis compared to non-CMR cases in terms of 3-year RFS and 3-years OS.

PS02.131: PATTERN OF LYMPHATIC METASTASIS OF CERVICAL ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 158-158
Author(s):  
Jiancheng Li ◽  
Xiuling Shi
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Conflicts Of Interest ◽  
Mediastinal Lymph Node ◽  
Radical Resection ◽  
Cervical Esophageal Cancer ◽  
Cervical Lymph Nodes ◽  
Node Metastasis

Abstract Background Cervical esophageal cancer were rarely surgeryed Analysis and discussion of lymph node metastasis of cervical esophageal cancer Methods From July 2008 to June 2017, 10 cases of successful esophagectomy of cervical esophageal cance in our hospital underwent radical resection. Surgical dissection range was the neck and the upper mediastinum. A total of 231 lymph nodes were dissected. The lymph nodes were summarized and grouped in different ways, and analyzed the law of lymph node metastasis. Results 7 cases of esophageal cancer, lymph node metastasis occurred, and the rate of lymph node metastasis was 70% (7/10), of which 1 case was T1b stage. 17 lymph node metastases, the degree of lymph node metastasis was 7.36% (17/231), including 4 esophageal lymph nodes, 12 cervical lymph nodes and 1 upper right mediastinal lymph node. Conclusion Cervical esophageal cancer lymph node metastasis can spread occur early metastasis, and the metastasis site were mainly in neck.. Disclosure All authors have declared no conflicts of interest.

RA02.01: COMPARISON OF THREE-FIELD VERSUS TWO-FIELD LYMPHADENECTOMY FOR THORACIC MIDDLE AND LOWER ESOPHAGEAL CANCER: POST-OPERATIVE RESULTS OF A RANDOMIZED CONTROLLED TRIAL

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 19-20
Author(s):  
Bin Li ◽  
Jiaqing Xiang ◽  
Yawei Zhang ◽  
Jie Zhang ◽  
Yihua Sun ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Postoperative Complications ◽  
Lymph Nodes ◽  
Conflicts Of Interest ◽  
Tumor Staging ◽  
Operating Time ◽  
Thoracic Esophageal Cancer ◽  
Term Survival

Abstract Background Patients with esophageal cancer can benefit from extended lymphadenectomy. However, the role of 3-field lymphadenectomy is unclear, and the extent of lymphadenectomy for thoracic esophageal cancer is still under discussion. Methods From June 2013 to November 2016, 400 patients with middle and lower thoracic esophageal cancer were randomly assigned to receive 3-field (3FL, n = 200) or the 2-field (2FL, n = 200) lymphadenectomy. The postoperative complications, according to the Clavien-Dindo classification, and lymph node metastasis were compared on the basis of intention-to-treat principle. Results Baseline characteristics were balanced between the 2 arms. There were 187 patients (93.5%) had squamous cell carcinoma in 3FL arm, and 192 (96.0%) in the 2FL arm, P = 0262. According to the pathological reports, T staging in the 2 arms were comparable, however more N3 patients in the 3FL arm (10.5%, 21/200) than that in the 2FL arm (10%, 5/200), P = 0040. Consequently, less TNM staging I patients in the 3FL arm (16.0%, 32/200) than that in the 2FL arm (25.5%, 51/200), P = 0.019. Operating time was significantly longer in the 3FL arm (median, 183 vs. 168 [2FL] minutes, P < 0.001). Six patients in the 3FL arm (3%, 6/200) had reintubation, whereas no reintubation in the 2 FL arm (0%, 0/200), P = 0.030. Other postoperative complications were comparable in the 2 arms. One patient in the 2-field arm died of chyloperitoneum. According to the Clavien-Dindo classification of surgical complications, the distribution of severity were similar between the 2 arms, P = 0.416. More lymph nodes were resected in the 3FL arm (Median, 37 vs. 24 [2FL], P < 0.001). Lymph nodes resected in the mediastinum and upper abdomen were comparable between the 2 arms. 44 patients (22%) in the 3FL arm had positive lymph nodes. Conclusion Compared with 2-field lymphadenectomy, 3-field lymphadenectomy doesn’t increase the surgical risks for patients with thoracic esophageal cancer. 3-field lymphadenectomy can be performed safely, removing unforeseen cervical positive lymph node, and offering more accurate tumor staging. Long-term survival analysis under protocol will clarify the role of 3-field lymphadenectomy for esophageal cancer. Disclosure All authors have declared no conflicts of interest.

PS02.101: PREOPERATIVE TREATMENT BASED ON THE DCF CHEMOTHERAPY AND SUPPORTIVE THERAPY FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 149-150
Author(s):  
Shunsuke Tanabe ◽  
Yasuhiro Shirakawa ◽  
Naoaki Maeda ◽  
Takayuki Ninomiya ◽  
Kazuhiro Noma ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Neoadjuvant Chemotherapy ◽  
Adverse Events ◽  
Conflicts Of Interest ◽  
Clinical Stage ◽  
Supportive Therapy ◽  
Preoperative Treatment ◽  
Node Metastasis

Abstract Background The neoadjuvant chemotherapy using CDDP and 5-FU(CF) is the standard treatment for advanced esophageal cancer, defined as clinical stage II/III in Japan. However, more powerful chemotherapy has been required for the treatment of cases of cStageIII cases. In 2011, the combination treatment of CF and Docetaxel (DCF) was introduced for the treatment of those cases in our institute. DCF therapy increased chemotherapy remarkable cases. But, adverse events occur at high rates, including high myelosuppression. Therefore, it is necessary to ensure support by early intervention of supportive therapy so as not to exacerbate adverse events. We report about treatment outcome in preoperative DCF therapy cases. Methods We treated 128 esophageal cancer patients who underwent surgery following preoperative DCF therapy between 2011 and July 2017, and preoperative DCF was administered to 128 patients 2 course completely. The neoadjuvant chemotherapy regimen using DCF is Docetaxel:70mg/m2 (day1) + CDDP:70mg/m2 (day1) + 5-FU:700mg/m2 (day1–5). Results In the preoperative DCF group, overall response rate (over PR) was 51.5%. There were 37 cases in 128 cases of pathological tissue effect judgment for Grade 2 and 3. 14 cases of them (14cases/37cases:37.8%) had lymph node metastasis. Therefore it is necessary to control lymph node metastasis by surgery even in a remarkable group. Almost all patients experienced grade 4 adverse events, particularly neutropenia is a high frequency. From the start of chemotherapy, pretreatment of intraoral infection lesion and prevention and treatment of oral mucositis are performed. Considering the degree of myelosuppression during initial chemotherapy, in the second course, we actively administer G-CSF preparation. Conclusion A good prognosis can be expected if preoperative DCF therapy is effective. It is necessary to perform intensive and safe preoperative chemotherapy with appropriate supportive therapy intervention. Disclosure All authors have declared no conflicts of interest.

Detecting lymph node metastasis of esophageal cancer on dual-energy computed tomography

2020 ◽  
pp. 028418512098014
Author(s):  
Xuyang Sun ◽  
Tetsu Niwa ◽  
Soji Ozawa ◽  
Jun Endo ◽  
Jun Hashimoto
Keyword(s):  
Computed Tomography ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Late Phase ◽  
Ct Images ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
Short Axis ◽  
Phase Images ◽  
Fat Fraction

Background Using conventional computed tomography (CT), the accurate diagnosis of lymph node (LN) metastasis of esophageal cancer is difficult. Purpose To examine dual-energy CT parameters to predict LN metastasis preoperatively in patients with esophageal cancer. Material and Methods Twenty-six consecutive patients who underwent dual-energy CT before an esophageal cancer surgery (19 patients with LN metastases) were analyzed. The included LNs had a short-axis diameter of ≥4 mm and were confirmed to be resected on postoperative CT. Their short-axis diameter, CT value, iodine concentration (IC), and fat fraction were measured on early- and late-phase contrast-enhanced dual-energy CT images and compared between pathologically confirmed metastatic and non-metastatic LNs. Results In total, 51 LNs (34 metastatic and 17 non-metastatic) were included. In the early phase, IC and fat fraction were significantly lower in the metastatic than in the non-metastatic LNs (IC = 1.6 mg/mL vs. 2.2 mg/mL; fat fraction = 20.3% vs. 32.5%; both P < 0.05). Furthermore, in the late phase, IC and fat fraction were significantly lower in the metastatic than in the non-metastatic LNs (IC = 2.0 mg/mL vs. 3.0 mg/mL; fat fraction = 20.4% vs. 33.0%; both P < 0.05). Fat fraction exhibited accuracies of 82.4% and 78.4% on early- and late-phase images, respectively. Conversely, short-axis diameter and CT value on both early- and late-phase images were not significantly different between the metastatic and non-metastatic LNs ( P > 0.05). Conclusion Using dual-energy CT images, IC and fat fraction are useful for diagnosing LN metastasis in patients with esophageal cancer.

Assessment of cervical lymph node metastases using indirect computed tomography lymphography with iopamidol in a tongue VX2 carcinoma model

2011 ◽  
Vol 125 (8) ◽  
pp. 820-828 ◽  
Author(s):  
Y Shu ◽  
X Xu ◽  
Z Wang ◽  
W Dai ◽  
Y Zhang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Metastases ◽  
Cervical Lymph Node ◽  
Cervical Lymph Nodes ◽  
Cervical Lymph Node Metastases ◽  
Computed Tomography Images ◽  
Vx2 Carcinoma ◽  
Node Metastases

AbstractObjective:To investigate the performance of indirect computed tomography lymphography with iopamidol for detecting cervical lymph node metastases in a tongue VX2 carcinoma model.Materials and methods:A metastatic cervical lymph node model was created by implanting VX2 carcinoma suspension into the tongue submucosa of 21 rabbits. Computed tomography images were obtained 1, 3, 5, 10, 15 and 20 minutes after iopamidol injection, on days 11, 14, 21 (six rabbits each) and 28 (three rabbits) after carcinoma transplantation. Computed tomography lymphography was performed, and lymph node filling defects and enhancement characteristics evaluated.Results:Indirect computed tomography lymphography revealed bilateral enhancement of cervical lymph nodes in all animals, except for one animal imaged on day 28. There was significantly slower evacuation of contrast in metastatic than non-metastatic nodes. A total of 41 enhanced lymph nodes displayed an oval or round shape, or local filling defects. One lymph node with an oval shape was metastatic (one of 11, 9.1 per cent), while 21 nodes with filling defects were metastatic (21/30, 70 per cent). The sensitivity, specificity, accuracy, and positive and negative predictive values when using a filling defect diameter of 1.5 mm as a diagnostic criterion were 86.4, 78.9, 82.9, 82.6 and 83.3 per cent, respectively.Conclusion:When using indirect computed tomography lymphography to detect metastatic lymph nodes, filling defects and slow evacuation of contrast agent are important diagnostic features.

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