Preoperative diagnosis of lymph node metastasis in biliary and pancreatic carcinomas: evaluation of the combination of multi-detector CT and serum CA19-9 level.
BACKGROUND
It is difficult to diagnose lymph node metastasis in biliary and pancreas carcinomas before surgery.


OBJECTIVE
The aim of this study was to assess the utility of the combination of multi-detector computed tomographic (MDCT) findings and serum carbohydrate antigen (CA)19-9 level in the diagnosis of lymph node metastasis in biliary and pancreas carcinomas.


METHODS
The subjects were 139 patients with biliary and pancreas carcinomas who underwent surgical resection. We calculated the positive predictive values (PPV), sensitivities, specificities, positive likelihood ratios (PLR) and accuracies of diagnosis by MDCT alone, serum CA19-9 level alone, and their combination.


RESULTS
The PPV and sensitivity were higher for node metastasis in hepatoduodenal ligament than in common hepatic artery (CHA) or para-aortic region (PAR). Specificity, accuracy and PLR were highest for CHA in biliary carcinoma. With pancreatic carcinoma, PLR was slightly higher in PAR compared to other regions. The sensitivity of CA19-9 for node metastasis was higher than that of MDCT, while the PPV, specificity, accuracy and PLR were low for both biliary and pancreas carcinoma. The combination of positive CT findings and high CA19-9 level had the highest positive rate for node metastasis for both types of carcinomas. Nodes around the supra-mesenteric vein could not be fully observed on CT.


CONCLUSIONS
The combination of high-resolution MDCT and CA19-9 is useful for the diagnosis of lymph node metastasis in biliary and pancreas carcinomas.
Division of Surgical Oncology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. a-nanasm@nagasaki-u.ac.jp
Atsushi
A
Nanashima
Ichiro
I
Sakamoto
Tomayoshi
T
Hayashi
Syuuichi
S
Tobinaga
Masato
M
Araki
Masaki
M
Kunizaki
Takashi
T
Nonaka
Hiroaki
H
Takeshita
Shigekazu
S
Hidaka
Terumitsu
T
Sawai
Toru
T
Yasutake
Takeshi
T
Nagayasu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D018395:CA-19-9 Antigen / Q000097:blood*; D005260:Female; D006498:Hepatectomy; D006499:Hepatic Artery / Q000473:pathology; D006801:Humans; D008022:Ligaments / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D057234:Preoperative Period; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
D018395:CA-19-9 Antigen