OPTIMAL SIZE CRITERIA OF MALIGNANT LYMPH-NODES IN THE TREATMENT PLANNING OF RADIOTHERAPY FOR ESOPHAGEAL CANCER - EVALUATION BY COMPUTED-TOMOGRAPHY AND MAGNETIC-RESONANCE-IMAGING
T. Mizowaki et al., OPTIMAL SIZE CRITERIA OF MALIGNANT LYMPH-NODES IN THE TREATMENT PLANNING OF RADIOTHERAPY FOR ESOPHAGEAL CANCER - EVALUATION BY COMPUTED-TOMOGRAPHY AND MAGNETIC-RESONANCE-IMAGING, International journal of radiation oncology, biology, physics, 36(5), 1996, pp. 1091-1098
Citations number
30
Categorie Soggetti
Oncology,"Radiology,Nuclear Medicine & Medical Imaging
Purpose: To determine the optimal size criterion for detection of lymp
h node metastases from esophageal cancer for radiotherapy by computed
tomography (CT) and magnetic resonance (MR) imaging. Methods and Mater
ials: In 58 patients with esophageal cancer treated with subtotal esop
hagectomy and radical lymph node dissection the preoperative MR (n = 5
8) images and CT scans (n = 41) were reviewed. The relationship of the
CT and MR findings for the neck and mediastinum to the surgical and h
istopathological results was examined. Five size criteria on malignant
lymph nodes were used to construct receiver operating characteristic
(ROC) curves for CT and MR, and their detectabilities were evaluated.
Results: The specificities of both modalities at the cutoff of 3 mm sh
ort-axis diameter were lower than those at the cutoff of 5 mm or more.
In contrast, the sensitivities apparently decreased at the cutoff of
10 mm or more. The analysis of the ROC curves showed that the optimal
size criterion for malignant lymph nodes was 5 mm for both CT and MR.
When the criterion of 5 mm was used, the sensitivity, specificity, and
accuracy for CT was 68, 92, and 87%, respectively, and the respective
values for MR were 70, 93, and 89%. Although there was no significant
difference between the two ROC curves, MR was useful in distinguishin
g lymph nodes from vascular structures because of the flow void. Concl
usions: There was no significant difference between CT and MR in the d
etection of malignant lymph nodes from esophageal cancer. The optimal
size criterion for both CT and MR in the detection of cervical and med
iastinal lymph node metastases is 5 mm for short-axis diameter. These
results suggest that all regional lymph nodes of 5 mm or more on CT or
MR should be regarded as part of the gross tumor volume in the treatm
ent planning of radiotherapy for esophageal cancer. Copyright (C) 1996
Elsevier Science Inc.