Evaluating a preoperative protocol that includes magnetic resonance imaging for lymph node metastasis in the Cholangiocarcinoma Screening and Care Program (CASCAP) in Thailand

• Published in: World journal of surgical oncology 2017-09, Vol.15 (1), p.176-176, Article 176
• Main Authors: Songthamwat, Metha, Chamadol, Nittaya, Khuntikeo, Narong, Thinkhamrop, Jadsada, Koonmee, Supinda, Chaichaya, Nathaphop, Bethony, Jeffrey, Thinkhamrop, Bandit
• Format: Article
• Language: English
• Subjects: Accuracy; Aged; Bile; Bile Duct Neoplasms - diagnostic imaging; Bile Duct Neoplasms - mortality; Bile Duct Neoplasms - pathology; Bile Duct Neoplasms - surgery; Bile Ducts - diagnostic imaging; Bile Ducts - pathology; Biliary tract cancer; Biopsy; Carcinogens; Care and treatment; Cholangiocarcinoma; Cholangiocarcinoma - diagnostic imaging; Cholangiocarcinoma - mortality; Cholangiocarcinoma - pathology; Cholangiocarcinoma - surgery; Cholangiopancreatography, Magnetic Resonance - economics; Cholangiopancreatography, Magnetic Resonance - methods; Clinical Protocols; Cohort Studies; Cost-Benefit Analysis; Development and progression; Diagnosis; Early Detection of Cancer - economics; Early Detection of Cancer - methods; Female; Hepatectomy; Humans; Likelihood ratio; Liver; Liver cancer; Lymph; Lymph node metastasis; Lymph nodes; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymphatic metastasis; Lymphatic Metastasis - diagnostic imaging; Lymphatic system; Magnetic resonance imaging; Male; Medical imaging; Medical prognosis; Metastases; Metastasis; Middle Aged; NMR; Nuclear magnetic resonance; Patient Care Planning - economics; Patients; Predictive Value of Tests; Preoperative Care - economics; Preoperative Care - methods; Preoperative protocol; Prognosis; Resonance; Risk Assessment - methods; Risk factors; Screening; Sensitivity; Sensitivity and Specificity; Thailand; Ultrasonic imaging; Ultrasonography - economics; Ultrasonography - methods; Ultrasound
• ISSN: 1477-7819; 1477-7819
• DOI: 10.1186/s12957-017-1246-9

Treatment planning especially liver resection in cholangiocarcinoma (CCA) depends on the extension of tumor and lymph node metastasis which is included as a key criterion for operability. Magnetic resonance imaging (MRI) offers a rapid and powerful tool for the detection of lymph node metastasis (LNM) and in the current manuscript is assessed as a critical tool in the preoperative protocol for liver resection for treatment of CCA. However, the accuracy of MRI to detect LNM from CCA had yet to be comprehensively evaluated. The accuracy of MRI to detect LNM was assessed in a cohort of individuals with CCA from the Cholangiocarcinoma Screening and Care Program (CASCAP), a screening program designed to reduce CCA in Northeastern Thailand by community-based ultrasound (US) for CCA. CCA-positive individuals are referred to one of the nine tertiary centers in the study to undergo a preoperative protocol that included enhanced imaging by MRI. Additionally, these individuals also underwent lymph node biopsies for histological confirmation of LNM (the "gold standard") to determine the accuracy of the MRI results. MRI accurately detected the presence or absence of LNM in only 29 out of the 51 CCA cases (56.9%, 95% CI 42.2-70.7), resulting in a sensitivity of 57.1% (95% CI 34.0-78.2) and specificity of 56.7% (95% CI 37.4-74.5), with positive and negative predictive values of 48.0% (95% CI 27.8-68.7) and 65.4% (95% CI 44.3-82.8), respectively. The positive likelihood ratio was 1.32 (95% CI 0.76-2.29), and the negative likelihood ratio was 0.76 (95% CI 0.42-1.36). MRI showed limited sensitivity and a poor positive predictive value for the diagnosis of LNM for CCA, which is of particular concern in this resource-limited setting, where simpler detection methods could be utilized that are more cost-effective in this region of Thailand. Therefore, the inclusion of MRI, a costly imaging method, should be reconsidered as part of protocol for treatment planning of CCA, given the number of false positives, especially as it is critical in determining the operability for CCA subjects.