Surgery today · 2026
Poor-contrast areas in lymph nodes on contrast-enhanced computed tomography scan/magnetic resonance imaging are predictive of lymph node metastasis in patients with resected intrahepatic cholangiocarcinoma.
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Hagiwara Kei, Araki Kenichiro, Kubo Norio, Igarashi Takamichi, Tsukagoshi Mariko, Shibuya Kei, Asanaga Hiroyasu, Katsumata Natsumi, Ebara Masashi, Tokue Azusa, Takase Aya, Shirabe Ken
Аннотация
PURPOSE: Intrahepatic cholangiocarcinoma (ICC) with pathological lymph node metastasis (LNM) is associated with a poor prognosis. The standard treatment for ICC is surgical resection; however, the importance of prophylactic lymph node dissection (LND) is unclear. This study examined the predictive value of preoperative imaging for LNM from ICC.
METHODS: Forty patients with ICC underwent preoperative diagnostic imaging using contrast-enhanced computed tomography (CT), gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI), and positron emission tomography (PET)-CT, followed by liver resection with LND. Lymph node (LN) size (≥ 10 mm) and the presence of poor-contrast areas in LNs were evaluated using CT and EOB-MRI. Visually assessed positive LNs were evaluated by PET-CT.
RESULTS: LN size measured on CT and EOB-MRI could not predict pathological LNM. However, poor-contrast areas in LNs measured on CT (sensitivity, 55.0%; specificity, 95.0%) and EOB-MRI (sensitivity, 75.0%; specificity, 95.0%) could predict pathological LNM (pLNM), as could visually assessed positive LNs measured on PET-CT (sensitivity, 50.0%; specificity, 100.0%). LNs with poor-contrast areas measured on CT or MRI were an independent predictor of pLNM.
CONCLUSION: LNM was predicted by evaluating LNs with poor-contrast areas using contrast-enhanced CT or EOB-MRI. Thus, LNM risk should be assessed using EOB-MRI or/and contrast-enhanced CT scans before surgery.
METHODS: Forty patients with ICC underwent preoperative diagnostic imaging using contrast-enhanced computed tomography (CT), gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI), and positron emission tomography (PET)-CT, followed by liver resection with LND. Lymph node (LN) size (≥ 10 mm) and the presence of poor-contrast areas in LNs were evaluated using CT and EOB-MRI. Visually assessed positive LNs were evaluated by PET-CT.
RESULTS: LN size measured on CT and EOB-MRI could not predict pathological LNM. However, poor-contrast areas in LNs measured on CT (sensitivity, 55.0%; specificity, 95.0%) and EOB-MRI (sensitivity, 75.0%; specificity, 95.0%) could predict pathological LNM (pLNM), as could visually assessed positive LNs measured on PET-CT (sensitivity, 50.0%; specificity, 100.0%). LNs with poor-contrast areas measured on CT or MRI were an independent predictor of pLNM.
CONCLUSION: LNM was predicted by evaluating LNs with poor-contrast areas using contrast-enhanced CT or EOB-MRI. Thus, LNM risk should be assessed using EOB-MRI or/and contrast-enhanced CT scans before surgery.