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World J Surg Oncol. 2017 Sep 20;15(1):176. doi: 10.1186/s12957-017-1246-9.

Evaluating a preoperative protocol that includes magnetic resonance imaging for lymph node metastasis in the Cholangiocarcinoma Screening and Care Program (CASCAP) in Thailand.

Author information

1
Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
2
Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
3
Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, Thailand.
4
Liver Fluke and Cholangiocarcinoma Research Center, Khon Kaen University, Khon Kaen, Thailand.
5
Cholangiocarcinoma Center of Excellence, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
6
Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
7
Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
8
Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
9
Data Management and Statistical Analysis Center (DAMASAC), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
10
Department of Microbiology, Immunology, and Tropical Medicine, School of Medicine and Health Sciences, George Washington University, Washington, USA.
11
Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand. bandit@kku.ac.th.
12
Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, Thailand. bandit@kku.ac.th.
13
Data Management and Statistical Analysis Center (DAMASAC), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand. bandit@kku.ac.th.

Abstract

BACKGROUND:

Treatment planning especially liver resection in cholangiocarcinoma (CCA) depends on the extension of tumor and lymph node metastasis which is included as a key criterion for operability. Magnetic resonance imaging (MRI) offers a rapid and powerful tool for the detection of lymph node metastasis (LNM) and in the current manuscript is assessed as a critical tool in the preoperative protocol for liver resection for treatment of CCA. However, the accuracy of MRI to detect LNM from CCA had yet to be comprehensively evaluated.

METHODS:

The accuracy of MRI to detect LNM was assessed in a cohort of individuals with CCA from the Cholangiocarcinoma Screening and Care Program (CASCAP), a screening program designed to reduce CCA in Northeastern Thailand by community-based ultrasound (US) for CCA. CCA-positive individuals are referred to one of the nine tertiary centers in the study to undergo a preoperative protocol that included enhanced imaging by MRI. Additionally, these individuals also underwent lymph node biopsies for histological confirmation of LNM (the "gold standard") to determine the accuracy of the MRI results.

RESULTS:

MRI accurately detected the presence or absence of LNM in only 29 out of the 51 CCA cases (56.9%, 95% CI 42.2-70.7), resulting in a sensitivity of 57.1% (95% CI 34.0-78.2) and specificity of 56.7% (95% CI 37.4-74.5), with positive and negative predictive values of 48.0% (95% CI 27.8-68.7) and 65.4% (95% CI 44.3-82.8), respectively. The positive likelihood ratio was 1.32 (95% CI 0.76-2.29), and the negative likelihood ratio was 0.76 (95% CI 0.42-1.36).

CONCLUSIONS:

MRI showed limited sensitivity and a poor positive predictive value for the diagnosis of LNM for CCA, which is of particular concern in this resource-limited setting, where simpler detection methods could be utilized that are more cost-effective in this region of Thailand. Therefore, the inclusion of MRI, a costly imaging method, should be reconsidered as part of protocol for treatment planning of CCA, given the number of false positives, especially as it is critical in determining the operability for CCA subjects.

KEYWORDS:

Accuracy; Cholangiocarcinoma; Lymph node metastasis; Magnetic resonance imaging; Preoperative protocol

PMID:
28931405
PMCID:
PMC5607577
DOI:
10.1186/s12957-017-1246-9
[Indexed for MEDLINE]
Free PMC Article

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