Author of 1 Presentation
SS 12.9 - Ultra-small superparamagnetic iron oxide-enhanced MRI for pre-operative lymph node staging in patients with pancreatic and periampullary carcinoma: a feasibility study
Abstract
Purpose
An important negative prognostic factor for adenocarcinomas of the pancreas and periampullary region is the presence of para-aortic lymph node (LN) metastases, which are regarded as distant metastases. Determining LN status is challenging but may be possible with MRI with ultra-small superparamagnetic iron oxide (USPIO) particles, which have proven valuable for detecting LN metastases of solid tumors. The aim is to validate USPIO-MRI for pathology in patients with pancreatic or periampullary cancer.
Material and methods
Analysis of an ongoing feasibility study in patients undergoing resection of pancreatic or periampullary adenocarcinoma (N=14). LNs are scored on MRI, divided between regional and distant, and matched to histopathology of resected specimens.
Results
One patient was excluded due to perioperative peritoneal metastases. In the remaining 13 patients, in total 307 LNs were detected on MRI. In total, 293 LNs were analyzed histopathologically. On MRI, 28/78 regional and 58/229 distant LNs were suspected for metastases. On histopathology, 35/260 regional and 3/33 distant LNs were positive for metastases. Not all suspected distant LNs were resected. The regional LNs were assessed on a per-patient basis. Five patients had suspicious LNs with positive LNs histopathologically, 4 patients had negative LNs on MRI, but positive LNs histopathologically and 4 patients had negative LNs on MRI with negative LNs histopathologically.
Conclusion
The preliminary results show that on patient basis it is possible to detect regional LN metastases with USPIO-MRI. Further analysis of the data, including node-to-node analysis and follow-up, will provide more insight into the value of USPIO-MRI in these patients.
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Poster Author of 1 e-Poster
SE-052 - TNM-staging of duodenal adenocarcinoma with CECT
Author of 1 Presentation
SE-052 - TNM-staging of duodenal adenocarcinoma with CECT
Abstract
Purpose
Determine the accuracy of staging of duodenal adenocarcinoma (DA) with contrast-enhanced CT. DA represents over 50% of small bowel adenocarcinomas. Patients usually present with non-specific symptoms, causing significant delay in diagnosis. Currently, it is unclear what would be the optimal diagnostic workup. LN metastases are of most prognostic importance.
Material and methods
Retrospective evaluation of TNM-stage of DA on portal-venous CECT (N=50).
Results
The tumor was isodense in 46% (23/50), hypodense in 30% (15/50), hyperdense in 2% (1/50) of mixed density in 12% (6/50) and not visible in 10% (5/50). Tumors were mostly localized in the pars descendens (22/50=44%). 35 patients underwent surgery, 28 were resected; 7 had unexpected metastases (N=4) or local invasion (N=3). T-stage in resected patients was correct in 13 (13/28=46%), overestimated in 2 (2/28=7%), underestimated in 10 (10/28=36%); in 3 patients T-stage could not be determined. 21/28 of resected patients had suspicious lymph nodes (LNs), only 13 of these had positive LNs at pathology. In 7 patients without suspicious LNs, 3 had positive LNs at pathology. Seven patients were classified as M1, all confirmed (pathology=4; 18FDG-PET=2; follow-up=1). Ten patients as Mx, 2 confirmed (pathology=1; 18FDG-PET=1), 3 were negative (18FDG-PET=1; follow-up=2) and 5 patients lost to follow-up. 3/37 patients classified as M0 turned out to have metastases (liver=1; peritoneum=2).
Conclusion
CECT only is probably not sufficient for staging of DA; T-stage was incorrect in 54%, N-stage in 39%, M-stage in 26%. Especially LN staging is prognostically important. Therefore, future research is needed to improve staging of DA and aid therapy stratification.
Author of 1 Presentation
SS 12.9 - Ultra-small superparamagnetic iron oxide-enhanced MRI for pre-operative lymph node staging in patients with pancreatic and periampullary carcinoma: a feasibility study (ID 928)
Abstract
Purpose
An important negative prognostic factor for adenocarcinomas of the pancreas and periampullary region is the presence of para-aortic lymph node (LN) metastases, which are regarded as distant metastases. Determining LN status is challenging but may be possible with MRI with ultra-small superparamagnetic iron oxide (USPIO) particles, which have proven valuable for detecting LN metastases of solid tumors. The aim is to validate USPIO-MRI for pathology in patients with pancreatic or periampullary cancer.
Material and methods
Analysis of an ongoing feasibility study in patients undergoing resection of pancreatic or periampullary adenocarcinoma (N=14). LNs are scored on MRI, divided between regional and distant, and matched to histopathology of resected specimens.
Results
One patient was excluded due to perioperative peritoneal metastases. In the remaining 13 patients, in total 307 LNs were detected on MRI. In total, 293 LNs were analyzed histopathologically. On MRI, 28/78 regional and 58/229 distant LNs were suspected for metastases. On histopathology, 35/260 regional and 3/33 distant LNs were positive for metastases. Not all suspected distant LNs were resected. The regional LNs were assessed on a per-patient basis. Five patients had suspicious LNs with positive LNs histopathologically, 4 patients had negative LNs on MRI, but positive LNs histopathologically and 4 patients had negative LNs on MRI with negative LNs histopathologically.
Conclusion
The preliminary results show that on patient basis it is possible to detect regional LN metastases with USPIO-MRI. Further analysis of the data, including node-to-node analysis and follow-up, will provide more insight into the value of USPIO-MRI in these patients.