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International Journal of Clinical Oncology

, Volume 24, Issue 1, pp 46–52 | Cite as

Diagnostic accuracy of magnetic resonance imaging and computed tomography for lateral lymph node metastasis in rectal cancer: a systematic review and meta-analysis

  • Nobuaki HoshinoEmail author
  • Katsuhiro Murakami
  • Koya Hida
  • Takashi Sakamoto
  • Yoshiharu Sakai
Review Article
  • 143 Downloads

Abstract

Purpose

Accurate diagnosis of lateral lymph node metastasis is a major concern in rectal cancer. Metastasis is not only a poor prognostic factor, but it can also affect decisions about treatment options, such as preoperative chemoradiotherapy and lateral lymph node dissection. The purpose of this review was to assess the diagnostic performance of magnetic resonance imaging and computed tomography for lateral lymph node metastasis in rectal cancer.

Methods

A literature search was systematically performed using PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. All studies in which preoperative magnetic resonance imaging or computed tomography findings involving the lateral lymph nodes were compared with pathologic findings were included. Two authors independently assessed the literature and extracted the data, and any disagreement was resolved by discussion. Pooled sensitivity, specificity, and diagnostic odds ratios were estimated using hierarchical summary receiver-operating characteristic curve analysis. The methodologic quality of the included studies was assessed using the QUADAS-2 tool.

Results

Nine studies were included in the meta-analysis of magnetic resonance imaging. The pooled sensitivity, specificity, and diagnostic odds ratio for magnetic resonance imaging were 0.72 [95% confidence interval (CI) 0.66–0.78], 0.80 (95% CI 0.73–0.85), and 10.2 (95% CI 6.4–16.3), respectively. Pooled analyses were not conducted for computed tomography because of the small number of studies (only three could be identified) and the wide range in diagnostic performance between these studies.

Conclusions

Magnetic resonance imaging was useful to diagnose lateral lymph node metastasis in rectal cancer, especially due to high specificity.

Keywords

Diagnostic accuracy Systematic review Rectal neoplasms Lateral lymph node Magnetic resonance imaging 

Notes

Acknowledgements

This review was funded by Japan Society for the Promotion of Science (Grant no. 16K10538).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10147_2018_1349_MOESM1_ESM.docx (18 kb)
Supplementary material 1 (DOCX 17 KB)
10147_2018_1349_MOESM2_ESM.docx (24 kb)
Supplementary material 2 (DOCX 23 KB)
10147_2018_1349_MOESM3_ESM.eps (538 kb)
Fig. S1 Summary plot of the sensitivity and specificity of computed tomography. White spots indicate the points for each study. (EPS 537 KB)

References

  1. 1.
    Tan KY, Yamamoto S, Fujita S et al (2010) Improving prediction of lateral node spread in low rectal cancers—multivariate analysis of clinicopathological factors in 1046 cases. Langenbecks Arch Surg 395:545–549CrossRefGoogle Scholar
  2. 2.
    Fujita S, Yamamoto S, Akasu T et al (2009) Risk factors of lateral pelvic lymph node metastasis in advanced rectal cancer. Int J Colorectal Dis 24:1085–1090CrossRefGoogle Scholar
  3. 3.
    Ueno M, Oya M, Azekura K et al (2005) Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg 92:756–763CrossRefGoogle Scholar
  4. 4.
    Quadros CA, Falcão MF, Carvalho ME et al (2012) Metastases to retroperitoneal or lateral pelvic lymph nodes indicated unfavorable survival and high pelvic recurrence rates in a cohort of 102 patients with low rectal adenocarcinoma. J Surg Oncol 106:653–658CrossRefGoogle Scholar
  5. 5.
    Kim TG, Park W, Choi DH et al (2014) Factors associated with lateral pelvic recurrence after curative resection following neoadjuvant chemoradiotherapy in rectal cancer patients. Int J Colorectal Dis 29:193–200CrossRefGoogle Scholar
  6. 6.
    Beart RW (2007) Multidisciplinary management of patients with advanced rectal cancer. Clin Cancer Res 13:6890s–6893sCrossRefGoogle Scholar
  7. 7.
    Kusters M, Beets GL, van de Velde CJ et al (2009) A comparison between the treatment of low rectal cancer in Japan and the Netherlands, focusing on the patterns of local recurrence. Ann Surg 249:229–235CrossRefGoogle Scholar
  8. 8.
    Glimelius B (2013) Neo-adjuvant radiotherapy in rectal cancer. World J Gastroenterol 19:8489–8501CrossRefGoogle Scholar
  9. 9.
    Gollins S, Sebag-Montefiore D (2016) Neoadjuvant treatment strategies for locally advanced rectal cancer. Clin Oncol (R Coll Radiol) 28:146–151CrossRefGoogle Scholar
  10. 10.
    Kanemitsu Y, Komori K, Shida D et al (2017) Potential impact of lateral lymph node dissection (LLND) for low rectal cancer on prognoses and local control: a comparison of 2 high-volume centers in Japan that employ different policies concerning LLND. Surgery 162:303–314CrossRefGoogle Scholar
  11. 11.
    Fujita S, Yamamoto S, Akasu T et al (2003) Lateral pelvic lymph node dissection for advanced lower rectal cancer. Br J Surg 90:1580–1585CrossRefGoogle Scholar
  12. 12.
    Kusters M, Slater A, Muirhead R et al (2017) What to do with lateral nodal disease in low locally advanced rectal cancer? A call for further reflection and research. Dis Colon Rectum 60:577–585CrossRefGoogle Scholar
  13. 13.
    Sammour T, Chang GJ (2017) Lateral node dissection in low rectal cancer: time for a global approach? Ann Surg 266:208–209CrossRefGoogle Scholar
  14. 14.
    Smith JJ, Garcia-Aguilar J (2015) Advances and challenges in treatment of locally advanced rectal cancer. J Clin Oncol 33:1797–1808CrossRefGoogle Scholar
  15. 15.
    Franke AJ, Parekh H, Starr JS et al (2017) Total neoadjuvant therapy: a shifting paradigm in locally advanced rectal cancer management. Clin Colorectal Cancer 17:1–12CrossRefGoogle Scholar
  16. 16.
    Nagasaki T, Akiyoshi T, Fujimoto Y et al (2017) Preoperative chemoradiotherapy might improve the prognosis of patients with locally advanced low rectal cancer and lateral pelvic lymph node metastases. World J Surg 41:876–883CrossRefGoogle Scholar
  17. 17.
    Kim HJ, Choi GS, Park JS et al (2017) Optimal treatment strategies for clinically suspicious lateral pelvic lymph node metastasis in rectal cancer. Oncotarget 8:100724–100733Google Scholar
  18. 18.
    Maeda K, Maruta M, Utsumi T et al (2003) Bladder and male sexual functions after autonomic nerve-sparing TME with or without lateral node dissection for rectal cancer. Tech Coloproctol 7:29–33CrossRefGoogle Scholar
  19. 19.
    Kyo K, Sameshima S, Takahashi M et al (2006) Impact of autonomic nerve preservation and lateral node dissection on male urogenital function after total mesorectal excision for lower rectal cancer. World J Surg 30:1014–1019CrossRefGoogle Scholar
  20. 20.
    Saito S, Fujita S, Mizusawa J et al (2016) Male sexual dysfunction after rectal cancer surgery: results of a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for patients with lower rectal cancer: Japan Clinical Oncology Group Study JCOG0212. Eur J Surg Oncol 42:1851–1858CrossRefGoogle Scholar
  21. 21.
    Ogawa S, Hida J, Ike H et al (2016) The important risk factor for lateral pelvic lymph node metastasis of lower rectal cancer is node-positive status on magnetic resonance imaging: study of the Lymph Node Committee of Japanese Society for Cancer of the Colon and Rectum. Int J Colorectal Dis 31:1719–1728CrossRefGoogle Scholar
  22. 22.
    Otowa Y, Yamashita K, Kanemitsu K et al (2015) Treating patients with advanced rectal cancer and lateral pelvic lymph nodes with preoperative chemoradiotherapy based on pretreatment imaging. Onco Targets Ther 8:3169–3173CrossRefGoogle Scholar
  23. 23.
    Ogawa S, Hida J, Ike H et al (2016) Selection of lymph node-positive cases based on perirectal and lateral pelvic lymph nodes using magnetic resonance imaging: study of the Japanese Society for Cancer of the Colon and Rectum. Ann Surg Oncol 23:1187–1194CrossRefGoogle Scholar
  24. 24.
    Whiting PF, Rutjes AW, Westwood ME et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155:529–536CrossRefGoogle Scholar
  25. 25.
    Cochrane Methods Screening and Diagnostic Tests. https://methods.cochrane.org/sdt/handbook-dta-reviews. Accessed Aug 2018
  26. 26.
    Rutter CM, Gatsonis CA (2001) A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations. Stat Med 20:2865–2884CrossRefGoogle Scholar
  27. 27.
    Leeflang MM, Deeks JJ, Gatsonis C et al (2008) Systematic reviews of diagnostic test accuracy. Ann Intern Med 149:889–897CrossRefGoogle Scholar
  28. 28.
    Akasu T, Iinuma G, Takawa M et al (2009) Accuracy of high-resolution magnetic resonance imaging in preoperative staging of rectal cancer. Ann Surg Oncol 16:2787–2794CrossRefGoogle Scholar
  29. 29.
    Akiyoshi T, Matsueda K, Hiratsuka M et al (2015) Indications for lateral pelvic lymph node dissection based on magnetic resonance imaging before and after preoperative chemoradiotherapy in patients with advanced low-rectal cancer. Ann Surg Oncol 22(Suppl 3):S614–S620CrossRefGoogle Scholar
  30. 30.
    Dev K, Veerenderkumar KV, Krishnamurthy S (2018) Incidence and predictive model for lateral pelvic lymph node metastasis in lower rectal cancer. Indian J Surg Oncol 9:150–156CrossRefGoogle Scholar
  31. 31.
    Ishibe A, Ota M, Watanabe J et al (2016) Prediction of lateral pelvic lymph-node metastasis in low rectal cancer by magnetic resonance imaging. World J Surg 40:995–1001CrossRefGoogle Scholar
  32. 32.
    Kim MJ, Hur BY, Lee ES et al (2018) Prediction of lateral pelvic lymph node metastasis in patients with locally advanced rectal cancer with preoperative chemoradiotherapy: focus on MR imaging findings. PLoS One 13:e0195815CrossRefGoogle Scholar
  33. 33.
    Matsuoka H, Nakamura A, Masaki T et al (2007) Optimal diagnostic criteria for lateral pelvic lymph node metastasis in rectal carcinoma. Anticancer Res 27:3529–3533Google Scholar
  34. 34.
    Ogawa S, Itabashi M, Hirosawa T et al (2014) Lateral pelvic lymph node dissection can be omitted in lower rectal cancer in which the longest lateral pelvic and perirectal lymph node is less than 5 mm on MRI. J Surg Oncol 109:227–233CrossRefGoogle Scholar
  35. 35.
    Kobayashi H, Kikuchi A, Okazaki S et al (2015) Diagnostic performance of multidetector row computed tomography for assessment of lymph node metastasis in patients with distal rectal cancer. Ann Surg Oncol 22:203–208CrossRefGoogle Scholar
  36. 36.
    Yano H, Saito Y, Takeshita E et al (2007) Prediction of lateral pelvic node involvement in low rectal cancer by conventional computed tomography. Br J Surg 94:1014–1019CrossRefGoogle Scholar
  37. 37.
    Al-Sukhni E, Milot L, Fruitman M et al (2012) Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol 19:2212–2223CrossRefGoogle Scholar
  38. 38.
    Zhang G, Cai YZ, Xu GH (2016) Diagnostic accuracy of MRI for assessment of T category and circumferential resection margin involvement in patients with rectal cancer: a meta-analysis. Dis Colon Rectum 59:789–799CrossRefGoogle Scholar
  39. 39.
    Ueno H, Mochizuki H, Hashiguchi Y et al (2007) Potential prognostic benefit of lateral pelvic node dissection for rectal cancer located below the peritoneal reflection. Ann Surg 245:80–87CrossRefGoogle Scholar
  40. 40.
    Matsuoka H, Masaki T, Sugiyama M et al (2007) Morphological characteristics of lateral pelvic lymph nodes in rectal carcinoma. Langenbecks Arch Surg 392:543–547CrossRefGoogle Scholar
  41. 41.
    Ishida H, Hatano S, Ishiguro T et al (2012) Prediction of lateral lymph node metastasis in lower rectal cancer: analysis of paraffin-embedded sections. Jpn J Clin Oncol 42:485–490CrossRefGoogle Scholar
  42. 42.
    Hatano S, Ishida H, Ishiguro T et al (2015) Prediction of metastasis to mesorectal, internal iliac and obturator lymph nodes according to size criteria in patients with locally advanced lower rectal cancer. Jpn J Clin Oncol 45:35–42CrossRefGoogle Scholar

Copyright information

© Japan Society of Clinical Oncology 2018

Authors and Affiliations

  1. 1.Department of SurgeryKyoto University Graduate School of MedicineKyotoJapan

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