Value of cardiophrenic angle lymph nodes for the diagnosis of colorectal peritoneal carcinomatosis.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 372-372
Author(s):  
Caroline Caramella ◽  
David Malka ◽  
Edwige Pottier ◽  
Diane Goéré ◽  
Valerie Boige ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Nodes ◽  
Ct Scan ◽  
Peritoneal Carcinomatosis ◽  
Odds Ratio ◽  
Multivariate Analyses ◽  
Ct Scans ◽  
Lymph Node Status ◽  
Preoperative Ct ◽  
Potential Sign

372 Background: The radiological diagnosis of peritoneal carcinomatosis (PC) is challenging. Metastases in the cardiophrenic angle lymph nodes (CPALN) have been anecdotally reported in patients with abdominopelvic malignancies. We aimed to assess whether CPALN detected by computed tomography (CT)-scan are associated with PC in patients with colorectal cancer (CRC). Methods: Between 2007 and 2010, 550 patients with CRC, including 165 (30%) with PC, underwent surgery with complete exploration of the peritoneal cavity in our center. We retrospectively reviewed preoperative CT-scans for the presence of CPALN, and assessed the association of CPALN with surgically confirmed PC by univariate and multivariate analyses. Results: CPALN were present in 123 (75%) of the 165 patients with PC, but absent in 263 (68%) of the 385 patients without PC (sensitivity (Se), 0.72; specificity (Sp), 0.68; positive predictive value (PPV), 0.49; negative PV (NPV), 0.85; odds ratio [OR], 3.3; p<0.001). The presence of CPALN was not correlated with the extent of PC, the primary tumor and lymph node status , or the presence, number, size and location of liver metastases. Among the 165 patients with PC, 99 (60%) had visible signs of PC (other than CPALN) on CT-scan; among the remaining 66 patients, CPALN were the only potential sign of CP in 41 (62%), leading to Se, Sp, PPV, and NPV in patients with no signs of CP (other than CPALN) on CT of 0.62, 0.68, 0.24, and 0.92, respectively. Conclusions: The detection of CPALN on CT may be of valuable help for the diagnosis of PC in patients with CRC.

scholarly journals Correlation between preoperative CT scan and lung metastases according to surgical approach in patients with colorectal cancer

2021 ◽  
Author(s):  
Jorge Hernández ◽  
Laureano Molins ◽  
Juan J. Fibla ◽  
Ángela Guirao ◽  
Juan J. Rivas ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Ct Scan ◽  
Surgical Approach ◽  
Lung Metastases ◽  
Preoperative Ct

GEWF Solution

2001 ◽  
Vol 125 (5) ◽  
pp. 642-645 ◽  
Author(s):  
Ken J. Newell ◽  
Barry W. Sawka ◽  
Brian F. Rudrick ◽  
David K. Driman
Keyword(s):  
Colorectal Cancer ◽  
Lymph Nodes ◽  
Glacial Acetic Acid ◽  
Bowel Wall ◽  
Health Centre ◽  
Lymph Node Status ◽  
Regional Health ◽  
Tumor Penetration ◽  
Colorectal Cancer Resection ◽  
Positive Lymph Nodes

Abstract Background.—Lymph node status is an important prognostic factor in the staging of colorectal carcinoma. Several adjunctive solutions have been used to increase the yield of pericolic lymph nodes from colorectal cancer resection specimens. Methods.—During 1998 at the Grey Bruce Regional Health Centre (Owen Sound, Ontario), 67 colonic resections were performed for colorectal cancer. Lymph nodes were identified using GEWF solution (glacial acetic acid, ethanol, distilled water, and formaldehyde) in 35 cases, and by the conventional method of sectioning, inspection, and palpation in 32 cases. Results.—There were no significant differences between GEWF and non-GEWF cases with respect to patient age, length of resection, size of tumor, tumor histologic type, tumor differentiation, or depth of tumor penetration into the bowel wall. Use of GEWF led to a significant increase in the number of lymph nodes found (10.2 ± 4.9 per case) compared with non-GEWF cases (6.8 ± 3.9 per case) (P = .002). In GEWF cases 358 lymph nodes were identified, 82 with metastases, whereas in the non-GEWF cases 218 lymph nodes were found, 41 with metastases. The size of positive lymph nodes in the GEWF group (0.5 ± 0.2 cm) was significantly smaller than in the non-GEWF group (0.7 ± 0.4 cm) (P = .046). A greater percentage of positive lymph nodes in the GEWF cases (49/82, 60%) were 0.5 cm or smaller compared with the non-GEWF cases (17/41, 41%). Conclusions.—GEWF increases the yield of lymph nodes recovered from colorectal cancer specimens and may lead to improved staging of this cancer; it is inexpensive and simple to use.

scholarly journals Prognostic Impact of the Number of Examined Lymph Nodes in Stage II Colorectal Adenocarcinoma: A Retrospective Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Purun Lei ◽  
Ying Ruan ◽  
Jianpei Liu ◽  
Qixian Zhang ◽  
Xiao Tang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Stage Ii ◽  
Lymph Node Status ◽  
Stage Migration ◽  
Prognostic Impact ◽  
Disease Specific Survival ◽  
Stage Ii Colorectal Cancer ◽  
Disease Specific

Background. Evaluation of lymph node status is critical in colorectal carcinoma (CRC) treatment. However, as patients with node involvement may be incorrectly classified into earlier stages if the examined lymph node (ELN) number is too small and escape adjuvant therapy, especially for stage II CRC. The aims of this study were to assess the impact of the ELN on the survival of patients with stage II colorectal cancer and to determine the optimal number. Methods. Data from the US Surveillance, Epidemiology, and End Results (SEER) database on stage II resected CRC (1988-2013) were extracted for mathematical modeling as ELN was available since 1988. Relationship between ELN count and stage migration and disease-specific survival was analyzed by using multivariable models. The series of the mean positive LNs, odds ratios (ORs), and hazard ratios (HRs) were fitted with a LOWESS (Locally Weighted Scatterplot Smoothing) smoother, and the structural break points were determined by the Chow test. An independent cohort of cases from 2014 was retrieved for validation in 5-year disease-specific survival (DSS). Results. An increased ELN count was associated with a higher possibility of metastasis LN detection (OR 1.010, CI 1.009-1.011, p<0.001) and better DSS in LN negative patients (OR 0.976, CI 0.975-0.977, p<0.001). The cut-off point analysis showed a threshold ELN count of 21 nodes (HR 0.692, CI 0.667-0.719, p<0.001) and was validated with significantly better DSS in the SEER 2009 cohort CRC (OR 0.657, CI 0.522-0.827, p<0.001). The cut-off value of the ELN count in site-specific surgeries was analyzed as 20 nodes in the right hemicolectomy (HR 0.674, CI 0.638-0.713, p<0.001), 19 nodes in left hemicolectomy (HR 0.691, CI 0.639-0.749, p<0.001), and 20 nodes in rectal resection patients (HR 0.671, CI 0.604-0.746, p<0.001), respectively. Conclusions. A higher number of ELNs are associated with more-accurate node staging and better prognosis in stage II CRCs. We recommend that at least 21 lymph nodes be examined for accurate diagnosis of stage II colorectal cancer.

scholarly journals Prognostic Value of Lymphovascular Invasion in Stage Ⅱ Colorectal Cancer Patients with an Inadequate Examination of Lymph Nodes.

2021 ◽  
Author(s):  
Zhenyan Gao ◽  
Huihua Cao ◽  
Xiang Xu ◽  
Qing Wang ◽  
Yugang Wu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Nodes ◽  
Prognostic Value ◽  
Multivariate Analyses ◽  
Disease Free Survival ◽  
Staging System ◽  
Tnm Staging ◽  
Tnm Staging System ◽  
Kras Status ◽  
Serum Cea

Abstract BackgroundLymphovascular invasion (LVI) is defined as the existence of cancer cells in lymphatics or blood vessels. This study aimed to evaluate the prognostic value of LVI in stage Ⅱ colorectal cancer (CRC) patients with inadequate examination of lymph nodes (ELNs) and further combined LVI with the TNM staging system to determine the predictive efficacy for CRC prognosis. Adjuvant chemotherapy (ACT) was then evaluated for stage Ⅱ CRC patients with LVI positivity (LVI +).MethodsThe clinicopathologic records of 1420 CRC patients treated at the Third Affiliated Hospital of Soochow University between February 2007 and February 2013 were retrospectively reviewed. LVI was examined by hematoxylin-eosin (HE) staining. Kaplan-Meier analysis followed by a log-rank test was used to analyze survival rates. Univariate and multivariate analyses were performed using a Cox proportional hazards model. The Harrell’s concordance index (C-index) was used to evaluate the accuracy of different systems in predicting prognosis.ResultsThe LVI status was significantly associated with pT stage, degree of differentiation, tumor stage, serum CEA and CA19-9 levels, perineural invasion (PNI) and KRAS status. The 5-year overall survival (OS) rate of stage Ⅱ patients with < 12 ELNs and LVI + was less than stage ⅢA. Multivariate analyses showed that LVI, pT-stage, serum CEA and CA19-9 levels, PNI and KRAS status were significant prognostic factors for stage Ⅱ patients with < 12 ELNs. The 8th TNM staging system combined with LVI showed a higher C-index than the 8th TNM staging system alone (C-index, 0.895 vs. 0.833). Among patients with LVI + the ACT group had a significantly higher 5-year OS and 5-year disease-free survival (DFS) than the surgery alone (SA) group (5-year OS, 66.7% vs. 40.9%, P = 0.004; 5-year DFS, 64.1% vs. 36.3%, P = 0.002).ConclusionsLVI is an independent prognostic risk factor for stage Ⅱ CRC patients. Combining LVI with the 8th TNM staging system improved the predictive accuracy for CRC prognosis. ACT in stage Ⅱ CRC patients with LVI + is beneficial for survival.

Utilization of imaging and outcomes of care among metastatic colorectal cancer (mCRC) patients (pts) receiving bevacizumab containing regimens.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14011-e14011
Author(s):  
Afsaneh Barzi ◽  
Hanke Zheng ◽  
Jeffrey McCombs
Keyword(s):  
Colorectal Cancer ◽  
Ct Scan ◽  
Standard Of Care ◽  
Median Number ◽  
Ct Scans ◽  
P Value ◽  
First Line ◽  
Probability Of Survival ◽  
First Line Therapy ◽  
Line Therapy

e14011 Background: Chemotherapy combined with bevacizumab is the most commonly used treatment first line therapy in pts with mCRC. Decisions for continuation or change of chemotherapy are based on the findings of CT scan, the most commonly used from of imaging in this population. Modeled after clinical trials, CT scan every 2 months is adopted as a standard of care. Yet, patterns of utilization of CT scan in general population is unknown. We set to explore CT scan utilization and associated outcomes among pts with mCRC. Methods: The De-identified Clinformatics Data Mart (OptumInsight, Eden Prairie, MN) covering January 2008 to December 2016 was used for this analysis. Pts with two out-patient and/or one in-patient ICD codes for colorectal cancer were identified. Pts with at least 180 days of enrollment, no chemotherapy within 120 days prior to chemotherapy, and at least one claim for CT scan were eligible for analysis. Recipients of FOLFOX (CAPOX) or FOLFIRI (XILIRI) +bevacizumab were identified using HCPCS codes and the data of their 1sttreatment was registered as index date. The primary endpoint of the analysis was exposure to both FOLFIRI and FOLFOX, secondary endpoint was survival. SAS software was used for data processing and analysis. Results: A total of 3261 pts met the inclusion criteria 78% with oxaliplatin based regimens and 22% with irinotecan regimens. The median age of the population is 66 (19-89), and 58.3% of the identified pts were male. The median duration of first line therapy was 119 days. Median number of CT scan during first line was 2.3. The median and mean number of CT scan per 2 months were 0.82 and 0.94. There was no difference in age, gender, and comorbidities in those with less than 2 vs. 2 or more CT scans. Exposure to both regimens (measured with switching from one regimen to another) was 35% in pts with less than 2 CT scans and 44% in those with 2 or more CT scan (p-value < 0.0001). Probability of survival at 12 months was 83% for all patients regardless of the frequency of scans. Conclusions: In patients with mCRC more frequent scans is associated with higher probability of access to active agents. However, survival probability at 12 months was not different between the two groups.

A computed tomography-based nomogram for preoperative prediction of synchronous peritoneal carcinomatosis in colorectal cancer.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 14-14
Author(s):  
Zixu Yuan ◽  
Wuteng Cao ◽  
Hui Wang ◽  
Jian Cai ◽  
Lei Wu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Peritoneal Carcinomatosis ◽  
Predictive Value ◽  
Clinical Decision ◽  
Tumor Location ◽  
Greater Omentum ◽  
Training Set ◽  
Test Set ◽  
Preoperative Prediction ◽  
Preoperative Ct

14 Background: Peritoneal carcinomatosis (PC) of colorectal cancer remain poor and is considered to be the terminal stage. Early detection of PC can bring survival benefit for chances of complete cytoreductive surgery. In this study, we have developed and validated a CT-based nomogram for preoperative prediction of synchronous PC in CRC. Methods: The CT-based nomogram optimized for image classification of PC was developed and validated in a large cohort. The specific features of synchronous PC were extracted from preoperative CT arterial stage scans by radiologists. A CT-based model was constructed by Boruta algorithm and multivariate logistic regression in the training set and validated in the test set. A CT-based nomogram was then built to predict the risk value of PC. The performance and efficacy of this nomogram to discriminate PC were assessed. Results: A total of 170 eligible CRC patients with synchronous PC were randomly divided into a training set (n = 92) and a validation set (n = 78). After processing and partition, five items of PC-related features including tumor location, cT stage, distant metastasis, thickened greater omentum and pelvic nodules were enrolled into this CT-based model. In the training set, the ROC shows AUC of CT-based model was 0.929(95% CI: 0.764-0.946). The sensitivity was 73.2% and the specificity was 98.3%. The positive predictive value (PPV) was 82.26%, while the negative predictive value (NPV) was 100%. In the test set, AUC by the ROC was 0.855(95% CI: 0.764-0.946). The sensitivity of CT-based model was 72.7% and the specificity was 93.3%. The PPV was 82.35%, while the NPV was 88.89%. These results show high predicted accuracy of CT-based model in diagnosis of synchronous PC both in the training set and test set. A nomogram based on these five preoperative predictors of PC was created. This CT-based nomogram showed good diagnostic performance by calibration curve. The decision curves analysis revealed high benefit of this CT-based nomogram in clinical decision. Conclusions: The CT-based nomogram has shown great potential in the detection and diagnosis of synchronous peritoneal metastasis in colorectal cancer.

Lymph Nodes Ratio Is Associated with the Survival of Colorectal Cancer Patients with Peritoneal Carcinomatosis

2011 ◽  
Vol 77 (5) ◽  
pp. 602-607 ◽  
Author(s):  
Kenji Matsuda ◽  
Tsukasa Hotta ◽  
Katsunari Takifuji ◽  
Yasuhito Kobayashi ◽  
Takeshi Tsuji ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Confidence Interval ◽  
Peritoneal Carcinomatosis ◽  
Lymph Node Ratio ◽  
Hazard Ratio ◽  
Lymph Node Status ◽  
Node Ratio ◽  
Colorectal Cancer Patients

The purpose of this study was to clarify the prognostic factors in patients with peritoneal carcinomatosis from colorectal origin, especially focusing on lymph node status. Between 1998 and 2007, 126 patients who underwent surgical treatment for primary colorectal cancer with peritoneal carcinomatosis were retrospectively assessed concerning prognostic factors. To estimate survival, we formulated a scoring system by numbers of independent poor prognostic factors. According to a multivariate analysis, extent of peritoneal carcinomatosis (hazard ratio, 1.93; 95% confidence interval, 1.19-3.13; P = 0.008) and lymph node ratio (hazard ratio, 1.87; 95% confidence interval, 1.05-3.33; P = 0.034) were found to be independent poor prognostic factors for survival. Furthermore, we demonstrated that score formulated by the number of these criteria was highly predictive of survival ( P < 0.001). The 5-year survival rate for patients with score 0 (having no criteria), score 1 (having one criterion), and score 2 (having two criteria) were 25.1 per cent, 6.2 per cent, and 0 per cent, respectively. Lymph node ratio is an important prognostic factor in addition to the extent of peritoneal carcinomatosis after resection of primary colorectal carcinoma. Patients without these criteria have a favorable outcome, and therefore should be considered for further aggressive surgery and intraperitoneal chemotherapy.

Sign in / Sign up

Export Citation Format

Share Document