title: Retrospective cohort study of portacaval lymphadenopathy identified on multidetector CT and implications for follow-up.
abstract: OBJECTIVE
  Portacaval lymphadenopathy (PCLA) is common in cirrhosis and chronic viral hepatitis and is frequently an incidental finding on abdominal CT scans. We aimed to detect the incidence of malignancy in organs drained by portacaval nodes in patients with PCLA associated with cirrhosis or chronic viral hepatitis, or incidentally detected PCLA.
  
  
  METHODS
  We searched CT reports from 2005 to 2007 for the phrases "periportal node" and "portacaval node." MDCTs of patients with portacaval nodes ≥10 mm in maximal short-axis size on contrast-enhanced MDCTs, were included. Records were reviewed for presence of malignancy, liver metastases, chronic viral hepatitis, and cirrhosis. Clinical or imaging follow-up ≥6 months was performed to detect if malignancy developed in organs drained by portacaval nodes in patients with incidental PCLA, cirrhosis, or chronic viral hepatitis.
  
  
  RESULTS
  479 patients met inclusion criteria [298 males (62%), mean age 61.4 years]. In 285 (59.5%) patients, PCLA was explained by local pathology or systemic lymphadenopathy. PCLA was incidental in 146 (30.5%) patients. Of these, 112 (76.7%) had ≥6 months of follow-up (median 26 months). No patient with incidental PCLA developed malignancy in organs drained by these nodes. Cirrhosis or chronic viral hepatitis was present in 48 (10.0%) patients. Of these, 42 (87.5%) had ≥6 months follow-up (median 28 months), and only 1 patient developed cholangiocarcinoma (positive predictive value 2.4%).
  
  
  CONCLUSIONS
  Development of malignancy is rare in patients with PCLA, either incidental or secondary to cirrhosis or chronic viral hepatitis. Our study suggests that no follow-up of PCLA is required in these settings.
authors.affiliation: Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA, iyerx063@umn.edu.
authors.forename: Veena R
authors.initials: VR
authors.lastname: Iyer
authors.forename: Sandeep S
authors.initials: SS
authors.lastname: Hedgire
authors.forename: Sumedh S
authors.initials: SS
authors.lastname: Hoskote
authors.forename: David
authors.initials: D
authors.lastname: Borczuk
authors.forename: Mukesh G
authors.initials: MG
authors.lastname: Harisinghani
mesh_terms: D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011169:Portal Vein / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*