Perihepatic lymph node assessment in patients undergoing partial hepatectomy for malignancy Journal Article
| Authors: | Grobmyer, S. R.; Wang, L.; Gonen, M.; Fong, Y.; Klimstra, D.; D'Angelica, M.; DeMatteo, R. P.; Schwartz, L.; Blumgart, L. H.; Jarnagin, W. R. |
| Article Title: | Perihepatic lymph node assessment in patients undergoing partial hepatectomy for malignancy |
| Abstract: | OBJECTIVE: To assess the value of preoperative imaging studies and the intraoperative assessment of perihepatic lymph nodes in patients undergoing partial hepatectomy for malignancy. SUMMARY BACKGROUND DATA: Perihepatic lymph node status is an important prognostic factor for patients undergoing hepatic resection for 1° and metastatic cancer. The value of preoperative imaging studies and intraoperative assessment of perihepatic nodes is unknown. METHODS: Perihepatic lymph nodes were sampled in 100 patients undergoing resection for 1° and metastatic hepatic malignancy. At the time of sampling, participating surgeons assigned a clinical suspicion score (scale, 1-5: 1 = clinically negative, 5 = clinically positive). Preoperative CT scans and PET scans were reviewed in a blinded fashion by 2 radiologists. Clinical assessment, CT, and PET scan results were analyzed in the context of the pathologic status of the lymph nodes. RESULTS: A mean of 3.2 ± 0.2 nodes were sampled per patient. Fifteen patients had metastatic disease in perihepatic lymph nodes; 13 had suggestive findings on preoperative CT or PET, and 2 were clinically positive at exploration. Clinical assessment had a high negative predictive value (NPV) = 99% but a low positive predictive value (PPV) = 39%. Similarly, CT scans had a high NPV = 95% and a low PPV = 30%. PET scans had a NPV = 88% and a PPV of 100%. Of the 48 patients with both negative preoperative CT and PET scans, only 1 (2.1%) had metastatic nodal disease, and this was suspected based on the clinical assessment. Of the patients with negative CT and PET scans and a negative clinical assessment (n = 39), none had involved perihepatic nodes. CONCLUSIONS: In patients with 1 and metastatic liver cancer, the incidence of truly occult metastatic disease to perihepatic lymph nodes is low. Routine sampling of perihepatic lymph nodes will therefore have a low yield in patients without some evidence of disease on preoperative CT or PET scans or at the time of exploration. Copyright © 2006 by Lippincott Williams & Wilkins. |
| Keywords: | human tissue; major clinical study; carcinoma, hepatocellular; liver neoplasms; cancer patient; positron emission tomography; lymph node metastasis; cancer incidence; lymph nodes; lymphatic metastasis; neoplasm staging; diagnostic accuracy; sensitivity and specificity; intraoperative care; lymph node excision; prospective studies; metastasis; computer assisted tomography; tomography, x-ray computed; diagnostic imaging; liver carcinoma; liver; statistical analysis; preoperative period; radiologist; surgeon; positron-emission tomography; scoring system; predictive value of tests; hepatectomy; bile duct carcinoma; bile duct neoplasms; bile ducts, intrahepatic; cholangiocarcinoma; lymph node biopsy; partial hepatectomy; single-blind method |
| Journal Title: | Annals of Surgery |
| Volume: | 244 |
| Issue: | 2 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2006-08-01 |
| Start Page: | 260 |
| End Page: | 264 |
| Language: | English |
| DOI: | 10.1097/01.sla.0000217606.59625.9d |
| PUBMED: | 16858189 |
| PROVIDER: | scopus |
| PMCID: | PMC1602169 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 33" - "Export Date: 4 June 2012" - "CODEN: ANSUA" - "Source: Scopus" |
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