CAN REGIONAL LYMPH NODE METASTASES FROM PANCREATIC CANCER BE PREDICTED WITH CROSS-SECTIONAL IMAGING?
katelyn flick*1, Ted A. Seltman2, Nicholas J. Zyromski1, Eugene P. Ceppa1, Christian Schmidt1, Attila Nakeeb1, Mark Tann2, Michael G. House1, Xin zhong3, Cameron Colgate4
1General Surgery, Indiana University, Indianapolis, IN; 2Radiology, Indiana University, Indianapolis, IN; 3Oncology, Indiana University, Indianapolis, IN; 4Biostatistics, Indiana University, Indianapolis, IN
Introduction
Lymph node (LN) metastasis is highly predictive of disease-specific survival for patients with pancreatic cancer. Local and regional LN assessment with cross-sectional imaging may identify patients at risk for early disease progression after resection of pancreatic cancer. The purpose of this study was to compare radiologic characteristics with final histopathologic findings of regional lymph nodes in patients undergoing pancreatoduodenectomy (PD).
Methods
Staff radiologists were blinded to the final histopathology findings for patients undergoing resection for pancreatic cancer. Radiologic interpretations of preoperative CT images were evaluated for the LN status along the celiac axis. Findings were then recorded with regards to the likelihood of nodal metastasis at this level. Two categories of findings were established: benign or suspicious for metastases. Two-way comparisons were performed between radiologic interpretation and final histopathologic findings.
Results
Forty-six cases were assessed. All PD specimens were confirmed as pancreatic ductal adenocarcinoma with the exception two cases of mucinous adenocarcinoma and two of chronic inflammation. Histopathology revealed an average tumor size of 3.3 cm (±0.16). Among all cases, an average number of 23 LNs were examined, with a mean of almost 5 positive for malignancy. The majority (78%) of cases were staged as pT3N1. Negative surgical margins were achieved in 87% of resections. Metastatic LN disease along the celiac axis was established pathologically in 9 (20%) patients, exclusively at the station 8 LN level. The sensitivity, specificity, negative and positive predictive values of preoperative cross-sectional imaging for pathologic LN staging along the celiac axis was: 44%, 97%, 88%, and 80%, respectively.
Conclusions
Routine preoperative radiologic staging of celiac axis lymph node metastases is inaccurate for patients with pancreatic cancer. Findings of this study do not support further studying the utility of enhanced or functional cross-sectional imaging to detect locoregional LN involvement.
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