Value of cardiophrenic angle lymph node for the diagnosis of colorectal peritoneal carcinomatosis
Menée sur 550 patients atteints d'un cancer colorectal et ayant subi une intervention chirurgicale avec exploration complète du péritoine entre 2007 et 2011, cette étude française évalue l'intérêt de détecter par tomodensitométrie la présence de ganglions lymphatiques de l'angle cardio-phrénique pour diagnostiquer une carcinose péritonéale (165 cas)
Background : Cardiophrenic angle lymph nodes (CPALN) have been reported in patients with abdominopelvic malignancies. We aimed to assess whether the presence of CPALN is associated with peritoneal carcinomatosis (PC) in colorectal cancer.
Patients and methods : Between 2007 and 2011, 550 patients with colorectal cancer, including 165 (30%) with PC, had undergone surgery with complete peritoneal exploration. We retrospectively reviewed preoperative CT scans for the presence of CPALN and assessed its association with confirmed PC by univariate and multivariate analyses.
Results : CPALN were present in 123 (75%) patients with PC, but absent in 263 (68%) patients without PC (Se: 0.72; Sp: 0.68; PPV: 0.49; NPV: 0.85; [OR], 3.3; p < 0.001). PC was the only factor independently associated with CPALN in the multivariate analysis. CPALN was not correlated with the presence of liver metastases. 99 of the 165 patients with PC (62%) had visible signs of PC on CT scan. Among the remaining 66 patients, CPALN were the only potential sign of PC in 41 (62%), (Se 0.62, Sp 0.68, PPV 0.24, and NPV 0.92).
Conclusion : The detection of CPALN on CT may be of valuable help for the diagnosis of PC in patients with CRC.
European Journal of Cancer , résumé, 2012