A predictive nomogram improved diagnostic accuracy and interobserver agreement of perirectal lymph nodes metastases in rectal cancer

Abstract Background The aim of this study is to evaluate the microstructure and microcirculation of regional lymph nodes (LNs) in rectal cancer by using non-invasive intravoxel incoherent motion MRI (IVIM-MRI), and to distinguish metastatic from non-metastatic LNs by quantitative parameters. Methods All recruited patients underwent IVIM-MRI (b = 0, 5, 10, 20, 30, 40, 60, 80, 100, 150, 200, 400, 600, 1000, 1500 and 2000 s/mm2) on a 3.0 T MRI system. One hundred sixty-eight regional LNs with a short-axis diameter equal to or greater than 5 mm from 116 patients were evaluated by two radiologists independently, including 78 malignant LNs and 90 benign LNs. The following parameters were assessed: the short-axis diameter (S), long-axis diameter (L), short- to long-axis diameter ratio (S/L), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion factor (f). Intraclass correlation coefficients (ICCs) were calculated to assess the interobserver agreement between two readers. Receiver operating characteristic curves were applied for analyzing statistically significant parameters. Results Interobserver agreement of IVIM-MRI parameters between two readers was excellent (ICCs> 0.75). The metastatic group exhibited higher S, L and D (P < 0.001), but lower f (P < 0.001) than the non-metastatic group. The area under the curve (95% CI, sensitivity, specificity) of the multi-parameter combined equation for D, f and S was 0.811 (0.744~0.868, 62.82%, 87.78%). The diagnostic performance of the multi-parameter model was better than that of an individual parameter (P < 0.05). Conclusion IVIM-MRI parameters provided information about the microstructure and microcirculation of regional LNs in rectal cancer, also improved diagnostic performance in identifying metastatic LNs.

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Distribution and patterns of lymph nodes metastases and micrometastases in the mesorectum of rectal cancer

Journal of Surgical Oncology ◽

10.1002/jso.20826 ◽

2007 ◽

Vol 96 (3) ◽

pp. 213-219 ◽

Cited By ~ 20

Author(s):

Yang-Chun Zheng ◽

Zong-Guang Zhou ◽

Li Li ◽

Wen-Zhang Lei ◽

Yi-Ling Deng ◽

...

Keyword(s):

Rectal Cancer ◽

Lymph Nodes ◽

Lymph Nodes Metastases

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Evaluation of Rectal Cancer Patients with Lateral Pelvic Lymph Nodes Metastases

Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons) ◽

10.4030/jjcs1979.26.6_1429 ◽

2001 ◽

Vol 26 (6) ◽

pp. 1429-1433

Author(s):

Kotaro KITAHARA ◽

Kaoru MIYASHITA ◽

Yasuhiro OHHASHI ◽

Kazuya YAMAGUCHI ◽

Sinya ASAMI ◽

...

Keyword(s):

Rectal Cancer ◽

Lymph Nodes ◽

Cancer Patients ◽

Pelvic Lymph Nodes ◽

Lateral Pelvic Lymph Nodes ◽

Lymph Nodes Metastases

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861: Lymph Nodes Metastases in Patients with Prostate Cancer and with a PSA < 10NG/ML

The Journal of Urology ◽

10.1016/s0022-5347(18)38110-2 ◽

2004 ◽

Vol 171 (4S) ◽

pp. 228-228

Author(s):

Martin Schumacher ◽

Fiona C. Burkhard ◽

Regula Markwalder ◽

Urs E. Studer

Keyword(s):

Prostate Cancer ◽

Lymph Nodes ◽

Lymph Nodes Metastases

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Cervical lymph node enlargement as the initial manifestation of rectal cancer

BMC Gastroenterology ◽

10.1186/s12876-021-01628-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tong-Hui Xie ◽

Peng Su ◽

Jian-Guo Hong ◽

Hui Zhang

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Cervical Lymph Node ◽

Clinical Manifestations ◽

Initial Symptom ◽

Cervical Lymph Nodes ◽

Supraclavicular Lymph Nodes ◽

Lymph Node Enlargement

Abstract Background Colorectal cancer is a very common malignant tumor worldwide. The clinical manifestations of advanced colorectal cancer include the changes in bowel habits, hematochezia, diarrhea, local abdominal pain and other symptoms. However, the colorectal cancer with an initial symptom of cervical lymph node enlargement is extremely rare. In this article, we report a case of rectal cancer presenting with cervical lymph nodes enlargement as the initial symptom. Case presentation A 57-year-old woman was admitted to our hospital for cervical lymph node enlargement which was accidentally detected during physical examination. Computed tomography scan revealed multiple enlarged lymph nodes in the neck. Cervical ultrasound showed normal thyroid gland and multiple left supraclavicular lymph nodes enlargement. The patient underwent lymph nodes biopsy and pathologic results showed metastatic adenocarcinoma. The subsequent lower gastrointestinal endoscopy revealed a mucosal bulge lesion located at rectus and biopsy revealed adenocarcinoma. The patient underwent rectal cancer resection. She is alive with no evidence of recurrence or new tumors 2 years after surgery. Conclusions Cervical lymph node metastasis is a rare metastatic way in colorectal cancer. This is the first case of rectal cancer presenting with cervical lymph nodes metastases as the initial symptom. Surgical resection combined with postoperative chemotherapy improved long-term prognosis of the patient. This rare metastatic way of rectal cancer should be paid attention for clinicians.

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Pathological features of lymph nodes around inferior mesenteric artery in rectal cancer: a retrospective study

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02264-9 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Chunhui Jiang ◽

Ye Liu ◽

Chunjie Xu ◽

Yanying Shen ◽

Qing Xu ◽

...

Keyword(s):

Risk Factors ◽

Rectal Cancer ◽

Lymph Nodes ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Anal Verge ◽

T Stage ◽

Pathological Type ◽

Nerve Invasion ◽

Independent Risk Factors

Abstract Objective This study aimed to explore the pathological characteristics of lymph nodes around inferior mesenteric artery in rectal cancer and its risk factors and its impact on tumor staging. Methods 485 rectal cancer patients underwent proctectomy surgery were collected in this study. Clinical features of patients, including gender, age, BMI, tumor size, pathological type, differentiation, nerve invasion, lymph nodes, tumor marker, and pathological examinations, were analyzed. Results A total of 485 cases were included in this study. There were 29 cases with IMA-LN metastasis; the metastasis rate was 5.98% (29/485). Positive IMA-LNs were associated with distance from anal verge, CEA, pathological type, differentiation, nerve invasion, T stage, and N stage. Multivariate analysis showed that distance from anal verge, CEA level, differentiation, and T stage were independent risk factors for positive IMA-LNs. Conclusion Distance from anal verge, CEA level, differentiation, and T stage were independent risk factors for positive IMA-LNs. No skip metastasis occurred in IMA-LNs. We should choose the appropriate surgical methods to achieve better oncological results and reduce the incidence of postoperative complications.

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T stage-dependent lymph node and distant metastasis and the accuracy of lymph node assessment in rectal cancer

European Surgery ◽

10.1007/s10353-021-00714-y ◽

2021 ◽

Author(s):

Henry Ptok ◽

Frank Meyer ◽

Roland S. Croner ◽

Ingo Gastinger ◽

Benjamin Garlipp

Keyword(s):

Rectal Cancer ◽

Overall Survival ◽

Lymph Node ◽

Lymph Nodes ◽

False Negative ◽

Cumulative Risk ◽

Distant Metastases ◽

Number Of Patients ◽

Tumor Stages ◽

The Impact

Summary Objective To analyze data obtained in a representative number of patients with primary rectal cancer with respect to lymph node diagnostics and related tumor stages. Methods In pT2-, pT3-, and pT4 rectal cancer lesions, the impact of investigated lymph nodes on the frequency of pN+ status, the cumulative risk of metachronous distant metastases, and overall survival was studied by means of a prospective multicenter observational study over a defined period of time. Results From 2000 to 2011, the proportion of surgical specimens with ≥ 12 investigated lymph nodes increased significantly, from 73.6% to 93.2% (p < 0.001; the number of investigated lymph nodes from 16.2 to 20.8; p < 0.001). Despite this, the percentage of pN+ rectal cancer lesions varied only non-significantly (39.9% to 45.9%; p = 0.130; median, 44.1%). For pT2-, pT3-, and pT4 rectal cancer lesions, there was an increasing proportion of pN+ findings correlating significantly with the number of investigated lymph nodes up to n = 12 investigated lymph nodes. Only in pT3 rectal cancer was there a significant increase in pN+ findings in case of > 12 lymph nodes (p = 0.001), but not in pT2 (p = 0.655) and pT4 cancer lesions (p = 0.256). For pT3pN0cM0 rectal cancer, the risk of metachronous distant metastases and overall survival did not depend on the number of investigated lymph nodes. Conclusion In rectal cancer, at least n = 12 lymph nodes are to be minimally investigated. The investigation of fewer lymph nodes is associated with a higher risk of false-negative pN0 findings. In particular, in pT3 rectal cancer, the investigation of more than 12 lymph nodes lowers the risk of false-negative pN0 findings. An upstaging effect by the investigation of a possibly maximal number of lymph nodes could not be detected.

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Apparent diffusion coefficient cannot discriminate metastatic and non-metastatic lymph nodes in rectal cancer: a meta-analysis

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03986-8 ◽

2021 ◽

Author(s):

Alexey Surov ◽

Hans-Jonas Meyer ◽

Maciej Pech ◽

Maciej Powerski ◽

Jasan Omari ◽

...

Keyword(s):

Rectal Cancer ◽

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Lymph Nodes ◽

Meta Analysis ◽

Adc Value ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph ◽

Apparent Diffusion ◽

Adc Values

Abstract Background Our aim was to provide data regarding use of diffusion-weighted imaging (DWI) for distinguishing metastatic and non-metastatic lymph nodes (LN) in rectal cancer. Methods MEDLINE library, EMBASE, and SCOPUS database were screened for associations between DWI and metastatic and non-metastatic LN in rectal cancer up to February 2021. Overall, 9 studies were included into the analysis. Number, mean value, and standard deviation of DWI parameters including apparent diffusion coefficient (ADC) values of metastatic and non-metastatic LN were extracted from the literature. The methodological quality of the studies was investigated according to the QUADAS-2 assessment. The meta-analysis was undertaken by using RevMan 5.3 software. DerSimonian, and Laird random-effects models with inverse-variance weights were used to account the heterogeneity between the studies. Mean DWI values including 95% confidence intervals were calculated for metastatic and non-metastatic LN. Results ADC values were reported for 1376 LN, 623 (45.3%) metastatic LN, and 754 (54.7%) non-metastatic LN. The calculated mean ADC value (× 10−3 mm2/s) of metastatic LN was 1.05, 95%CI (0.94, 1.15). The calculated mean ADC value of the non-metastatic LN was 1.17, 95%CI (1.01, 1.33). The calculated sensitivity and specificity were 0.81, 95%CI (0.74, 0.89) and 0.67, 95%CI (0.54, 0.79). Conclusion No reliable ADC threshold can be recommended for distinguishing of metastatic and non-metastatic LN in rectal cancer.

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