Preoperative MRI and CA19-9 for predicting occult lymph node metastasis in small pancreatic ductal adenocarcinoma (≤ 2 cm).

IF 3.2 3区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

BMC Medical Imaging Pub Date : 2025-08-06 DOI:10.1186/s12880-025-01854-3

Qiying Tang, Lei Li, Zhiwei Pan, Jianbo Li, Xiaolan Huang, Mengsu Zeng, Haitao Sun, Jianjun Zhou

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引用次数: 0

Abstract

Aim: Accurate prediction of occult lymph node metastasis (OLNM) in small pancreatic ductal adenocarcinoma (sPDAC) (≤ 2 cm) is crucial for curative management. This study aims to explore clinical and MRI features associated with OLNM in sPDAC and their pathological and prognostic implications.

Materials and methods: This retrospective study included 135 patients with pathologically confirmed sPDAC who underwent surgery between September 2014 and September 2023. Preoperative multi-sequence MRI, clinical data, and pathological features were analyzed. Univariate and multivariate logistic regression models were used to identify risk predictors of OLNM in sPDAC. Receiver operating characteristic (ROC) analysis was performed to assess diagnostic performance and Kaplan-Meier survival analysis was used to evaluate prognostic outcomes.

Results: OLNM was present in 43 (31.9%) sPDAC patients. Univariate and multivariate analysis identified elevated CA19-9 (> 100 U/mL) (OR = 2.404, P = 0.040) and low apparent diffusion coefficient (ADC) values (OR = 0.243, P = 0.031) as independent predictors of OLNM. The combined clinical-radiological model demonstrated an AUC of 0.740, significantly higher than CA19-9 (AUC = 0.653, P = 0.021) or ADC alone (AUC = 0.635, P = 0.035). sPDAC patients with OLNM exhibited higher rates of lymphovascular invasion (44.2%, P = 0.013) and pathological fat invasion (86.0%, P = 0.030). OLNM was associated with significantly worse OS and DFS (P = 0.034 and 0.043).

Conclusions: OLNM is associated with adverse pathological features and poorer prognosis. The combination of preoperative MRI assessment of ADC and CA19-9 may aid in identifying sPDAC patients at high risk for OLNM.

Clinical trial number: Not applicable.

Abstract Image

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术前MRI和CA19-9预测小胰腺导管腺癌（≤2 cm）隐匿淋巴结转移。

目的：准确预测小胰腺导管腺癌（sPDAC）（≤2 cm）隐匿淋巴结转移（OLNM）对治疗至关重要。本研究旨在探讨sPDAC中与OLNM相关的临床和MRI特征及其病理和预后意义。材料和方法：本回顾性研究纳入了2014年9月至2023年9月间接受手术的135例病理证实的sPDAC患者。分析术前多序列MRI、临床资料及病理特征。采用单因素和多因素logistic回归模型确定sPDAC患者发生OLNM的风险预测因素。采用受试者工作特征（ROC）分析评估诊断表现，采用Kaplan-Meier生存分析评估预后结果。结果：43例（31.9%）sPDAC患者存在OLNM。单因素和多因素分析表明，CA19-9升高（100 U/mL）（OR = 2.404, P = 0.040）和低表观扩散系数（ADC）值（OR = 0.243, P = 0.031）是OLNM的独立预测因子。临床-放射联合模型的AUC为0.740，显著高于CA19-9 （AUC = 0.653, P = 0.021）或ADC单独（AUC = 0.635, P = 0.035）。sPDAC合并OLNM患者淋巴血管浸润率（44.2%,P = 0.013）和病理性脂肪浸润率（86.0%,P = 0.030）较高。OLNM与较差的OS和DFS相关（P = 0.034和0.043）。结论：OLNM具有不良病理特征和较差的预后。术前MRI评估ADC和CA19-9可能有助于识别有OLNM高风险的sPDAC患者。临床试验号：不适用。

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来源期刊

BMC Medical Imaging RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-

CiteScore

4.60

自引率

3.70%

发文量

198

审稿时长

27 weeks

期刊介绍： BMC Medical Imaging is an open access journal publishing original peer-reviewed research articles in the development, evaluation, and use of imaging techniques and image processing tools to diagnose and manage disease.