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Publication
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| Title of Article |
Evaluating a preoperative protocol that
includes magnetic resonance imaging
for lymph node metastasis in the
Cholangiocarcinoma Screening and
Care Program (CASCAP) in Thailand |
| Date of Acceptance |
11 September 2017 |
| Journal |
| Title of Journal |
World Journal of Surgical Oncology |
| Standard |
ISI |
| Institute of Journal |
Biomed Central |
| ISBN/ISSN |
|
| Volume |
15 |
| Issue |
176 |
| Month |
December |
| Year of Publication |
2017 |
| Page |
|
| 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. |
| Keyword |
Cholangiocarcinoma, Magnetic resonance imaging, Lymph node metastasis, Accuracy, Preoperative protocol * |
| Author |
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| Reviewing Status |
มีผู้ประเมินอิสระ |
| Status |
ตีพิมพ์แล้ว |
| Level of Publication |
นานาชาติ |
| citation |
false |
| Part of thesis |
true |
| Attach file |
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| Citation |
0
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Journal Publication
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