Computed Tomography and Magnetic Resonance Imaging Evaluation of Pelvic Lymph Node Metastasis in Bladder Cancer

Overview

Journal Chin J Cancer

Publisher Biomed Central

Specialty Oncology

Date 2018 Jan 27

PMID 29370848

Citations 12

Authors

Yong Li

Feiyu Diao

Siya Shi

Kaiwen Li

Wangshu Zhu

Shaoxu Wu

Tianxin Lin

Affiliations

Soon will be listed here.

Abstract

Background: Accurate evaluation of lymph node metastasis in bladder cancer (BCa) is important for disease staging, treatment selection, and prognosis prediction. In this study, we aimed to evaluate the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) for metastatic lymph nodes in BCa and establish criteria of imaging diagnosis.

Methods: We retrospectively assessed the imaging characteristics of 191 BCa patients who underwent radical cystectomy. The data regarding size, shape, density, and diffusion of the lymph nodes on CT and/or MRI were obtained and analyzed using Kruskal-Wallis test and χ test. The optimal cutoff value for the size of metastatic node was determined using the receiver operating characteristic (ROC) curve analysis.

Results: A total of 184 out of 3317 resected lymph nodes were diagnosed as metastatic lymph nodes. Among 82 imaging-detectable lymph nodes, 51 were confirmed to be positive for metastasis. The detection rate of metastatic nodes increased along with more advanced tumor stage (P < 0.001). Once the ratio of short- to long-axis diameter ≤ 0.4 or fatty hilum was observed in lymph nodes on imaging, it indicated non-metastases. Besides, lymph nodes with spiculate or obscure margin or necrosis indicated metastases. Furthermore, the short diameter of 6.8 mm was the optimal threshold to diagnose metastatic lymph node, with the area under ROC curve of 0.815.

Conclusions: The probability of metastatic nodes significantly increased with more advanced T stages. Once lymph nodes are detected on imaging, the characteristic signs should be paid attention to. The short diameter > 6.8 mm may indicate metastatic lymph nodes in BCa.

Citing Articles

In Vivo Detection of Lymph Nodes Metastasis of ESCC Using CXCR4-Targeted Tracer [Cu]Cu-NOTA-CP01.

Peng T, Li Z, Gao J, Yang M, Qiu Y, Xian J Mol Imaging Biol. 2024; 26(6):1046-1056.

PMID: 39497002 DOI: 10.1007/s11307-024-01960-8.

Development and Validation of a Nomogram for Axillary Lymph Node Metastasis Risk in Breast Cancer.

Wang S, Zhang H, Wang X, Yu J, Zhang Q, Zheng Y J Cancer. 2024; 15(18):6122-6134.

PMID: 39440057 PMC: 11493017. DOI: 10.7150/jca.100651.

Management of patients with muscle-invasive bladder cancer with clinical evidence of pelvic lymph node metastases.

Grobet-Jeandin E, Lenfant L, Pinar U, Parra J, Mozer P, Renard-Penna R Nat Rev Urol. 2024; 21(6):339-356.

PMID: 38297079 DOI: 10.1038/s41585-023-00842-y.

Ultrasonographic findings of multicentric malignant lymphoma involving the urinary bladder in a dog: Diagnosis and monitoring during chemotherapy.

Martenne-Duplan A, Chervier C, Finck M Can Vet J. 2023; 64(9):844-848.

PMID: 37663028 PMC: 10426236.

Vascular Enlargement as a Predictor of Nodal Involvement in Bladder Cancer.

Borgheresi A, Agostini A, Sternardi F, Cesari E, Ventura F, Ottaviani L Diagnostics (Basel). 2023; 13(13).

PMID: 37443621 PMC: 10340831. DOI: 10.3390/diagnostics13132227.

References

Tilki D, Svatek R, Karakiewicz P, Isbarn H, Reich O, Kassouf W . Characteristics and outcomes of patients with pT4 urothelial carcinoma at radical cystectomy: a retrospective international study of 583 patients. J Urol. 2009; 183(1):87-93. DOI: 10.1016/j.juro.2009.08.145. View

Papalia R, Simone G, Grasso R, Augelli R, Faiella E, Guaglianone S . Diffusion-weighted magnetic resonance imaging in patients selected for radical cystectomy: detection rate of pelvic lymph node metastases. BJU Int. 2011; 109(7):1031-6. DOI: 10.1111/j.1464-410X.2011.10446.x. View

Barentsz J, Engelbrecht M, Witjes J, de la Rosette J, van der Graaf M . MR imaging of the male pelvis. Eur Radiol. 1999; 9(9):1722-36. DOI: 10.1007/s003300050916. View

Saokar A, Islam T, Jantsch M, Saksena M, Hahn P, Harisinghani M . Detection of lymph nodes in pelvic malignancies with Computed Tomography and Magnetic Resonance Imaging. Clin Imaging. 2010; 34(5):361-6. DOI: 10.1016/j.clinimag.2009.07.004. View

Thoeny H, Froehlich J, Triantafyllou M, Huesler J, Bains L, Vermathen P . Metastases in normal-sized pelvic lymph nodes: detection with diffusion-weighted MR imaging. Radiology. 2014; 273(1):125-35. DOI: 10.1148/radiol.14132921. View

Hu B, Satkunasivam R, Schuckman A, Sherrod A, Cai J, Miranda G . Significance of perivesical lymph nodes in radical cystectomy for bladder cancer. Urol Oncol. 2014; 32(8):1158-65. DOI: 10.1016/j.urolonc.2014.08.004. View

Giannarini G, Petralia G, Thoeny H . Potential and limitations of diffusion-weighted magnetic resonance imaging in kidney, prostate, and bladder cancer including pelvic lymph node staging: a critical analysis of the literature. Eur Urol. 2011; 61(2):326-40. DOI: 10.1016/j.eururo.2011.09.019. View

Soave A, John L, Dahlem R, Minner S, Engel O, Schmidt S . The Impact of Tumor Diameter and Tumor Necrosis on Oncologic Outcomes in Patients With Urothelial Carcinoma of the Bladder Treated With Radical Cystectomy. Urology. 2015; 86(1):92-8. DOI: 10.1016/j.urology.2015.03.036. View

Fleischmann A, Thalmann G, Markwalder R, Studer U . Extracapsular extension of pelvic lymph node metastases from urothelial carcinoma of the bladder is an independent prognostic factor. J Clin Oncol. 2005; 23(10):2358-65. DOI: 10.1200/JCO.2005.03.084. View

10.

Mir N, Sohaib S, Collins D, Koh D . Fusion of high b-value diffusion-weighted and T2-weighted MR images improves identification of lymph nodes in the pelvis. J Med Imaging Radiat Oncol. 2010; 54(4):358-64. DOI: 10.1111/j.1754-9485.2010.02182.x. View

11.

Zargar H, Zargar-Shoshtari K, Dundee P, Black P . Predicting occult lymph node-positive disease at the time of radical cystectomy: a systematic review. Minerva Urol Nefrol. 2016; 68(2):112-24. View

12.

Roy C, Bierry G, Matau A, Bazille G, Pasquali R . Value of diffusion-weighted imaging to detect small malignant pelvic lymph nodes at 3 T. Eur Radiol. 2010; 20(8):1803-11. DOI: 10.1007/s00330-010-1736-4. View

13.

Harisinghani M, Barentsz J, Hahn P, Deserno W, Tabatabaei S, van de Kaa C . Noninvasive detection of clinically occult lymph-node metastases in prostate cancer. N Engl J Med. 2003; 348(25):2491-9. DOI: 10.1056/NEJMoa022749. View

14.

Uematsu T, Sano M, Homma K . In vitro high-resolution helical CT of small axillary lymph nodes in patients with breast cancer: correlation of CT and histology. AJR Am J Roentgenol. 2001; 176(4):1069-74. DOI: 10.2214/ajr.176.4.1761069. View

15.

Stein J, Lieskovsky G, Cote R, Groshen S, Feng A, Boyd S . Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol. 2001; 19(3):666-75. DOI: 10.1200/JCO.2001.19.3.666. View

16.

Zhang Z, Dong P, Li Y, Liu Z, Yao K, Han H . Radical cystectomy for bladder cancer: oncologic outcome in 271 Chinese patients. Chin J Cancer. 2013; 33(3):165-71. PMC: 3966145. DOI: 10.5732/cjc.012.10312. View

17.

Nakai G, Matsuki M, Inada Y, Tatsugami F, Tanikake M, Narabayashi I . Detection and evaluation of pelvic lymph nodes in patients with gynecologic malignancies using body diffusion-weighted magnetic resonance imaging. J Comput Assist Tomogr. 2008; 32(5):764-8. DOI: 10.1097/RCT.0b013e318153fd43. View

18.

Triantafyllou M, Studer U, Birkhauser F, Fleischmann A, Bains L, Petralia G . Ultrasmall superparamagnetic particles of iron oxide allow for the detection of metastases in normal sized pelvic lymph nodes of patients with bladder and/or prostate cancer. Eur J Cancer. 2012; 49(3):616-24. DOI: 10.1016/j.ejca.2012.09.034. View

19.

Rechichi G, Galimberti S, Oriani M, Perego P, Valsecchi M, Sironi S . ADC maps in the prediction of pelvic lymph nodal metastatic regions in endometrial cancer. Eur Radiol. 2012; 23(1):65-74. DOI: 10.1007/s00330-012-2575-2. View

20.

Guo P, Huang Z, Yu P, Li K . Trends in cancer mortality in China: an update. Ann Oncol. 2012; 23(10):2755-2762. DOI: 10.1093/annonc/mds069. View