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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

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the optimum cutoff for lymph node size to identify cases positive for perirectal lymph node (PRLN) and lateral lymph node (LPLN) metastasis of lower rectal cancer on magnetic resonance imaging (MRI).

Methods

The subjects were 449 patients who underwent preoperative MRI. Mesorectal excision was performed in all patients (combined with lateral pelvic lymph node [LN] dissection in 324) between 2004 and 2013 at 6 institutes. Cases were classified as cN positive and cN negative on the basis of the short axis of the largest LN being greater than or equal to a cutoff or less than a cutoff, respectively. PRLN and LPLN diagnoses using 5 and 10 mm cutoffs were compared with histologic diagnoses. Of the 449 patients, 55 received preoperative chemoradiotherapy. MRI was only performed after this therapy in all of these patients.

Results

For PRLNs, 5 and 10 mm cutoffs gave area under the curve (AUC) values of 0.6364 and 0.5794, respectively. The 5 mm cutoff gave a significantly higher AUC value (P = 0.0152), with an accuracy of 63.7 %, sensitivity of 72.6 %, and specificity of 54.7 %. For right LPLNs, the respective AUC values were 0.7418 and 0.6326 (P = 0.0034), and the variables (5 mm cutoff) were 77.6, 68.6, and 79.7 %. For left LPLNs, AUC values were 0.7593 and 0.6559, respectively (P = 0.0057), and the variables (5 mm cutoff) were 79.3, 70.8, and 81.0 %.

Conclusions

Identification of LN-positive cases on the basis of PRLN and LPLN sizes was superior at a short-axis 5 mm cutoff. Size-based diagnosis of LN metastasis is simple and useful, but further investigation is needed to clarify whether it is superior to diagnosis based on morphology, such as shape, border, and signal intensity.

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Acknowledgment

This work was supported by the JSCCR.

Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery II, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan

    Shimpei Ogawa MD, PhD, Michio Itabashi MD, PhD & Shingo Kameoka MD, PhD

  2. Department of Surgery, Kindai University School of Medicine, Osaka-Sayama, Osaka, Japan

    Jin-ichi Hida MD, PhD

  3. Department of Surgery, Saiseikai Yokohama City Nanbu Hospital, Yokohama, Japan

    Hideyuki Ike MD, PhD

  4. Department of Surgery, Kurume University School of Medicine, Kurume, Japan

    Tetsushi Kinugasa MD, PhD

  5. Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan

    Mitsuyoshi Ota MD, PhD

  6. Department of Surgery, National Defense Medical College, Tokorozawa, Japan

    Eiji Shinto MD, PhD

  7. Department of Surgical Oncology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan

    Kenichi Sugihara MD, PhD

Authors
  1. Shimpei Ogawa MD, PhD
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  2. Jin-ichi Hida MD, PhD
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  3. Hideyuki Ike MD, PhD
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  4. Tetsushi Kinugasa MD, PhD
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  5. Mitsuyoshi Ota MD, PhD
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  6. Eiji Shinto MD, PhD
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  7. Michio Itabashi MD, PhD
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  8. Shingo Kameoka MD, PhD
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  9. Kenichi Sugihara MD, PhD
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Corresponding author

Correspondence to Jin-ichi Hida MD, PhD.

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Ogawa, S., Hida, Ji., Ike, H. et al. 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, 1187–1194 (2016). https://doi.org/10.1245/s10434-015-5021-2

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  • DOI: https://doi.org/10.1245/s10434-015-5021-2

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