Optimal diagnostic method using multidetector-row computed tomography for predicting lymph node metastasis in...

Area of Science:

• Radiology
• Oncology
• Surgical Pathology

Background:

• Accurate prediction of lymph node (LN) involvement in colorectal cancer is vital for preoperative treatment decisions and surgical planning.
• Multidetector-row computed tomography (MDCT) is increasingly used to assess nodal status.
• This study investigated novel MDCT findings for improved prediction of LN metastasis.

Purpose of the Study:

• To evaluate the efficacy of various MDCT measurements in predicting lymph node metastasis in colorectal cancer.
• To identify the most sensitive imaging parameter for detecting nodal involvement.
• To assess the added value of extranodal neoplastic spread (ENS) findings in improving prediction accuracy.

Main Methods:

• Seventy patients with colorectal cancer underwent MDCT prior to curative resection.
• Lymph nodes (LNs) with a short-axis diameter (SAD) ≥ 4 mm were analyzed.
• Measurements included 2D and 3D SAD, LAD, ratios, CT attenuation values, LN volume, and ENS presence.

Main Results:

• Two-dimensional long-axis diameter (2D LAD) was the most sensitive measure for LN metastasis (AUC=0.752).
• The presence of extranodal neoplastic spread (ENS) significantly improved predictive power when combined with 2D LAD (AUC=0.846, p<0.001).
• A 2D LAD cut-off value of 7.05 mm was identified.

Conclusions:

• Long-axis diameter (LAD) on axial MDCT imaging is the most sensitive indicator for predicting colorectal LN metastasis.
• Incorporating MDCT findings of extranodal neoplastic spread (ENS) further enhances the predictive accuracy.
• These findings can optimize preoperative assessment and surgical management of colorectal cancer.