Preoperative assessment of para-aortic lymph node metastasis in patients with pancreatic cancer.
BACKGROUND
Para-aortic lymph node (PALN) metastasis is an important prognostic factor in patients with pancreatic cancer, but accurate preoperative diagnosis is difficult. The objective of this study was to assess the accuracy of diagnosis of PALN by computed tomography (CT), magnetic resonance imaging (MRI), and (18)F-fluorodeoxyglucose positron-emission tomography (FDG-PET).


METHODS
From August 2005 to July 2008, 119 patients with invasive ductal adenocarcinoma of the pancreas were included in this study. PALNs with a longer diameter >10 mm on CT or MRI were suspected of being involved by metastasis, whereas FDG uptake exceeding that of the adjacent normal tissue was considered to be positive for metastasis on FDG-PET studies. The imaging findings were compared with the pathological diagnosis of PALN metastasis.


RESULTS
PALN dissection was performed in 71 patients (60.0%). Although histopathological examination revealed metastasis in 6 patients (8.5%), none of these patients was positive in any of the preoperative imaging studies. The longer diameter, the shorter diameter, the ratio of the two diameters, and the calculated lymph node volume showed no significant differences between patients with and without PALN metastasis.


CONCLUSIONS
Preoperative detection of PALN metastasis in patients with pancreatic cancer is very difficult. Intraoperative histopathological examination of frozen sections is necessary if radical resection is contemplated.
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University, 54 Shogoinkawaracho, Sakyoku, Kyoto, 606-8507, Japan.
Hisashi
H
Imai
Ryuichiro
R
Doi
Hiroyuki
H
Kanazawa
Naoko
N
Kamo
Masayuki
M
Koizumi
Toshihiko
T
Masui
Yasuhiro
Y
Iwanaga
Yoshiya
Y
Kawaguchi
Yasutsugu
Y
Takada
Hiroyoshi
H
Isoda
Shinji
S
Uemoto
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D016009:Chi-Square Distribution; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007564:Japan; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011300:Preoperative Care; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18