Annals of Surgical Oncology

, Volume 23, Issue 4, pp 1187–1194 | Cite as

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

  • Shimpei Ogawa
  • Jin-ichi Hida
  • Hideyuki Ike
  • Tetsushi Kinugasa
  • Mitsuyoshi Ota
  • Eiji Shinto
  • Michio Itabashi
  • Shingo Kameoka
  • Kenichi Sugihara
Colorectal Cancer



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).


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.


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 %.


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.


Rectal Cancer Positive Predictive Value Negative Predictive Value Diagnostic Performance Total Mesorectal Excision 



This work was supported by the JSCCR.


The authors declare no conflict of interest.


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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Shimpei Ogawa
    • 1
  • Jin-ichi Hida
    • 2
  • Hideyuki Ike
    • 3
  • Tetsushi Kinugasa
    • 4
  • Mitsuyoshi Ota
    • 5
  • Eiji Shinto
    • 6
  • Michio Itabashi
    • 1
  • Shingo Kameoka
    • 1
  • Kenichi Sugihara
    • 7
  1. 1.Department of Surgery IITokyo Women’s Medical University School of MedicineTokyoJapan
  2. 2.Department of SurgeryKindai University School of MedicineOsaka-SayamaJapan
  3. 3.Department of SurgerySaiseikai Yokohama City Nanbu HospitalYokohamaJapan
  4. 4.Department of SurgeryKurume University School of MedicineKurumeJapan
  5. 5.Gastroenterological CenterYokohama City University Medical CenterYokohamaJapan
  6. 6.Department of SurgeryNational Defense Medical CollegeTokorozawaJapan
  7. 7.Department of Surgical Oncology, Graduate SchoolTokyo Medical and Dental UniversityTokyoJapan

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