背景:我们试图确定胰腺神经内分泌肿瘤(pNETs)患者术前成像检测淋巴结转移(LNM)的准确性,以及描述术前成像淋巴结状态对生存的影响。
方法:在2000年至2020年期间接受pNETs治愈性切除的患者来自8个中心。计算机断层扫描(CT)的敏感性和特异性,磁共振成像(MRI),正电子发射断层扫描(PET)-CT,对LNM的OctreoScan进行了评估。术前淋巴结状态对淋巴结清扫术(LND)的影响,定义了总生存期和无复发生存期.
结果:在852名患者中,235(27.6%)个体在最终组织学检查(hN1)中患有LNM。敏感性,特异性,阳性预测值(PPV),阴性预测值(NPV)为12.4%,98.1%,71.8%,CT为74.4%,6.3%,100%,100%,核磁共振80.1%,9.5%,100%,100%,PET为58.7%,11.3%,97.5%,66.7%,奥曲扫描为70.8%,分别。在这些成像模式的任何组合的患者中,整体灵敏度,特异性,PPV,净现值为14.9%,97.9%,72.9%,75.1%,分别。术前成像N1(iN1)与较高的LND数量相关(iN113与iN09,p=0.003)和最终hN1的频率高于术前iN0(iN172.9%vs.iN024.9%,p<0.001)。与术前iN0相比,术前iN1与更高的复发风险相关(中位无复发生存期,iN1→hN147.5vs.iN0→hN192.7个月,p=0.05)。
结论:在最后的病理检查中,只有4%的LNM患者术前影像学检查可疑为LNM。在pNETs患者中,传统的成像方式对确定淋巴结状态的敏感性较低。
BACKGROUND: We sought to define the accuracy of preoperative imaging to detect lymph node metastasis (LNM) among patients with pancreatic neuroendocrine tumors (pNETs), as well as characterize the impact of preoperative imaging nodal status on survival.
METHODS: Patients who underwent curative-intent resection for pNETs between 2000 and 2020 were identified from eight centers. Sensitivity and specificity of computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)-CT, and OctreoScan for LNM were evaluated. The impact of preoperative lymph node status on lymphadenectomy (LND), as well as overall and recurrence-free survival was defined.
RESULTS: Among 852 patients, 235 (27.6%) individuals had LNM on final histologic examination (hN1). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 12.4%, 98.1%, 71.8%, and 74.4% for CT, 6.3%, 100%, 100%, and 80.1% for MRI, 9.5%, 100%, 100%, and 58.7% for PET, 11.3%, 97.5%, 66.7%, and 70.8% for OctreoScan, respectively. Among patients with any combination of these imaging modalities, overall sensitivity, specificity, PPV, and NPV was 14.9%, 97.9%, 72.9%, and 75.1%, respectively. Preoperative N1 on imaging (iN1) was associated with a higher number of LND (iN1 13 vs. iN0 9, p = 0.003) and a higher frequency of final hN1 versus preoperative iN0 (iN1 72.9% vs. iN0 24.9%, p < 0.001). Preoperative iN1 was associated with a higher risk of recurrence versus preoperative iN0 (median recurrence-free survival, iN1→hN1 47.5 vs. iN0→hN1 92.7 months, p = 0.05).
CONCLUSIONS: Only 4% of patients with LNM on final pathologic examine had preoperative imaging that was suspicious for LNM. Traditional imaging modalities had low sensitivity to determine nodal status among patients with pNETs.