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Lymph node size and its association with nodal metastasis in ductal adenocarcinoma of the pancreas

Journal of Pathology and Translational Medicine 2020년 54권 5호 p.387 ~ 395
신재훈, 신승범, 이재훈, 송기병, 황대욱, 김형중, 변재호, 조형준, 김송철, 홍승모,
소속 상세정보
신재훈 ( Shin Jae-Hoon ) - University of Ulsan College of Medicine Asan Medical Center Department of Pathology
신승범 ( Shin Seung-Beom ) - Korea University Department of Statistics
이재훈 ( Lee Jae-Hoon ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
송기병 ( Song Ki-Byung ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
황대욱 ( Hwang Dae-Wook ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
김형중 ( Kim Hyoung-Jung ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
변재호 ( Byun Jae-Ho ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
조형준 ( Cho Hyung-Jun ) - Korea University Department of Statistics
김송철 ( Kim Song-Cheol ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
홍승모 ( Hong Seung-Mo ) - University of Ulsan College of Medicine Asan Medical Center Department of Pathology

Abstract


Background: Although lymph node metastasis is a poor prognostic factor in patients with pancreatic ductal adenocarcinoma (PDAC), our understanding of lymph node size in association with PDAC is limited. Increased nodal size in preoperative imaging has been used to detect node metastasis. We evaluated whether lymph node size can be used as a surrogate preoperative marker of lymph node metastasis.

Methods: We assessed nodal size and compared it to the nodal metastatic status of 200 patients with surgically resected PDAC. The size of all lymph nodes and metastatic nodal foci were measured along the long and short axis, and the relationships between nodal size and metastatic status were compared at six cutoff points.

Results: A total of 4,525 lymph nodes were examined, 9.1% of which were metastatic. The mean size of the metastatic nodes (long axis, 6.9±5.0 mm; short axis, 4.3±3.1 mm) was significantly larger than that of the non-metastatic nodes (long axis, 5.0±4.0 mm; short axis, 3.0±2.0 mm; all p<.001). Using a 10 mm cutoff, the sensitivity, specificity, positive predictive value, overall accuracy, and area under curve was 24.8%, 88.0%, 17.1%, 82.3%, and 0.60 for the long axis and 7.0%, 99.0%, 40.3%, 90.6%, and 0.61 for the short axis, respectively.

Conclusions: The metastatic nodes are larger than the non-metastatic nodes in PDAC patients. However, the difference in nodal size was too small to be identified with preoperative imaging. The performance of preoperative radiologic imaging to predict lymph nodal metastasis was not good. Therefore, nodal size cannot be used a surrogate preoperative marker of lymph node metastasis.

키워드

Pancreas; Neoplasms; Lymph node; Size; Metastasis

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