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Improving CT detection sensitivity for nodal metastases in oesophageal cancer with combination of smaller size and lymph node axial ratio

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To investigate the value of CT with inclusion of smaller lymph node (LN) sizes and axial ratio to improve the sensitivity in diagnosis of regional lymph node metastases in oesophageal squamous cell carcinoma (OSCC).

Methods

The contrast-enhanced multidetector row spiral CT (MDCT) multiplanar reconstruction images of 204 patients with OSCC were retrospectively analysed. The long-axis and short-axis diameters of the regional LNs were measured and axial ratios were calculated (short-axis/long-axis diameters). Nodes were considered round if the axial ratio exceeded the optimal LN axial ratio, which was determined by receiver operating characteristic analysis.

Results

A positive predictive value (PPV) exceeding 50% is needed. This was achieved only with LNs larger than 9 mm in short-axis diameter, but nodes of this size were rare (sensitivity 37.3%, specificity 96.4%, accuracy 85.8%). If those round nodes (axial ratio exceeding 0.66 ) between 7 mm and 9 mm in size were considered metastases as well, it might improve the sensitivity to 67.2% with a PPV of 63.9% (specificity 91.6%, accuracy 87.2%).

Conclusion

Combination of a smaller size and axial ratio for LNs in MDCT as criteria improves the detection sensitivity for LN metastases in OSCC.

Key Points

• CT is widely used to assess metastatic lymph nodes.

• CT has low sensitivity in detecting metastases using conventional criteria.

• Diagnostic sensitivity of CT was improved by using lymph node axial ratio.

• New diagnostic criteria provide greater diagnostic confidence with PPVs exceeding 50%.

• New diagnostic criteria may help clinicians assess patients with oesophageal cancer.

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Abbreviations

LN:

Lymph node

MDCT:

Multi-detector row spiral computed tomography

OSCC:

Oesophageal squamous cell carcinoma

PPV:

Positive predictive value

ROC:

Receiver operating characteristic

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Author information

Author notes

  1. Jianfang Liu

    Present address: Capital Medical University Electric Power Teaching Hospital, Beijing, 100027, China

  2. Huafei Shao

    Present address: Affiliated Yantai Yuhuangding Hospital of Qingdao University Medical College, Yantai, 264000, China

  3. Jian Liu

    Present address: Meitan General Hospital, Beijing, 100028, China

Authors and Affiliations

  1. National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China

    Jianfang Liu, Zhu Wang, Dong Qu & Libo Yao

Authors
  1. Jianfang Liu
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  2. Zhu Wang
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  3. Huafei Shao
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  4. Dong Qu
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  5. Jian Liu
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Corresponding author

Correspondence to Zhu Wang.

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Guarantor

The scientific guarantor of this publication is Zhu Wang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Funding

This study received funding by The National Natural Science Foundation of China; grant number 61372192.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because of the retrospective nature of the study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• prognostic study

• performed at one institution

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Cite this article

Liu, J., Wang, Z., Shao, H. et al. Improving CT detection sensitivity for nodal metastases in oesophageal cancer with combination of smaller size and lymph node axial ratio. Eur Radiol 28, 188–195 (2018). https://doi.org/10.1007/s00330-017-4935-4

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  • DOI: https://doi.org/10.1007/s00330-017-4935-4

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