Diagnosis of lateral pelvic lymph node metastasis of T1 lower rectal cancer using diffusion‑weighted magnetic resonance imaging: A case report with lateral pelvic lymph node dissection of lower rectal cancer

Ogawa,Shimpei; Itabashi,Michio; Hirosawa,Tomoichiro; Hashimoto,Takuzo; Bamba,Yoshiko; Okamoto,Takahiro

doi:10.3892/mco.2016.797

Diagnosis of lateral pelvic lymph node metastasis of T1 lower rectal cancer using diffusion‑weighted magnetic resonance imaging: A case report with lateral pelvic lymph node dissection of lower rectal cancer

Authors:
- Shimpei Ogawa
- Michio Itabashi
- Tomoichiro Hirosawa
- Takuzo Hashimoto
- Yoshiko Bamba
- Takahiro Okamoto
View Affiliations

Affiliations: Department of Surgery II, School of Medicine, Tokyo Women's Medical University, Shinjuku‑ku, Tokyo 162‑8666, Japan
Published online on: March 2, 2016 https://doi.org/10.3892/mco.2016.797
Pages: 817-820

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The present study presented a 35‑year‑old female patient in whom fecal occult blood was detected in a medical check‑up. Colonoscopy revealed a superficial elevated‑type tumor with central depression in the lower rectum. The tumor was diagnosed as T1 deep invasive cancer. No swollen lymph nodes or distant metastasis were found on computed tomography or [18F]‑fluorodeoxyglucose‑positron emission tomography with computed tomography. However, a swollen right lateral pelvic lymph node (LPLN; short axis 4 mm) was revealed on magnetic resonance imaging (MRI). This lymph node exhibited high intensity on diffusion‑weighted imaging (DWI), suggesting metastasis. Low anterior resection, regional lymph node dissection and right LPLN dissection (LPLD) were performed. Histological analysis revealed metastasis in the right LPLN, as suggested by the high DWI intensity. The indication for LPLD in the current Japanese guidelines is based on the tumor location and depth of invasion (≥T3), however, not on the status of LPLN metastasis in pre‑operative evaluation. The present case was cT1, which is not included in this indication. DWI is sensitive for the diagnosis of lymph node metastasis of colorectal cancer, although inflammation‑induced swelling of lymph nodes in advanced rectal cancer may cause a false‑positive result, which is uncommon in T1 cases. Therefore, an LPLN with a high intensity DWI signal in T1 cases is likely to be metastasis‑positive. Pre‑operative DWI‑MRI may be useful for identifying LPLN metastasis when planning the treatment strategy in these cases. The present study suggested reinvestigation of the indication for LPLD with inclusion of LPLN status on pre‑operative imaging.

View Figures

View References

1	Georgiou P, Tan E, Gouvas N, Antoniou A, Brown G, Nicholls RJ and Tekkis P: Extended lymphadenectomy versus conventional surgery for rectal cancer: A meta-analysis. Lancet Oncol. 10:1053–1062. 2009. View Article : Google Scholar : PubMed/NCBI
2	Quadros CA, Falcão MF, Carvalho ME, Ladeia PA and Lopes A: Metastases to retroperitoneal or lateral pelvic lymph nodes indicated unfavorable survival and high pelvic recurrence rates in a cohort of 102 patients with low rectal adenocarcinoma. J Surg Oncol. 106:653–658. 2012. View Article : Google Scholar : PubMed/NCBI
3	Japanese Society for Cancer of the Colon and Rectum: Japanese classification of colorectal carcinoma (2nd). Tokyo: Kanehara: 2009.
4	Akiyoshi T, Watanabe T, Miyata S, Kotake K, Muto T and Sugihara K: Japanese society for cancer of the colon and rectum: Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer: Is it regional or distant disease? Ann Surg. 255:1129–1134. 2012. View Article : Google Scholar : PubMed/NCBI
5	Sugihara K, Kobayashi H, Kato T, Mori T, Mochizuki H, Kameoka S, Shirouzu K and Muto T: Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum. 49:1663–1672. 2006. View Article : Google Scholar : PubMed/NCBI
6	Ono K, Ochiai R, Yoshida T, Kitagawa M, Omagari J, Kobayashi H and Yamashita Y: Comparison of diffusion-weighted MRI and 2-[fluorine-18]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) for detecting primary colorectal cancer and regional lymph node metastases. J Magn Reson Imaging. 29:336–340. 2009. View Article : Google Scholar : PubMed/NCBI
7	Zhao Q, Liu L, Wang Q, Liang Z and Shi G: Preoperative diagnosis and staging of rectal cancer using diffusion-weighted and water imaging combined with dynamic contrast-enhanced scanning. Oncol Lett. 8:2734–2740. 2014.PubMed/NCBI
8	Kwee TC, Takahara T, Ochiai R, Koh DM, Ohno Y, Nakanishi K, Niwa T, Chenevert TL, Luijten PR and Alavi A: Complementary roles of whole-body diffusion-weighted MRI and 18F-FDG PET: The state of the art and potential applications. J Nucl Med. 51:1549–1558. 2010. View Article : Google Scholar : PubMed/NCBI
9	Torkzad MR, Påhlman L and Glimelius B: Magnetic resonance imaging (MRI) in rectal cancer: A comprehensive review. Insights Imaging. 1:245–267. 2010. View Article : Google Scholar : PubMed/NCBI
10	Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, Hamaguchi T, Hyodo I, Igarashi M, Ishida H, et al: Japanese society for cancer of the colon and rectum (JSCCR) guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol. 20:207–239. 2015. View Article : Google Scholar : PubMed/NCBI
11	Klessen C, Rogalla P and Taupitz M: Local staging of rectal cancer: The current role of MRI. Eur Radiol. 17:379–389. 2007. View Article : Google Scholar : PubMed/NCBI
12	Schmoll HJ, Van Cutsem E, Stein A, Valentini V, Glimelius B, Haustermans K, Nordlinger B, van de Velde CJ, Balmana J, Regula J, et al: ESMO consensus guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making. Ann Oncol. 23:2479–2516. 2012. View Article : Google Scholar : PubMed/NCBI
13	Al-Sukhni E, Milot L, Fruitman M, Beyene J, Victor JC, Schmocker S, Brown G, McLeod R and Kennedy E: Diagnostic accuracy of MRI for assessment of T category, lymph node metastases and circumferential resection margin involvement in patients with rectal cancer: A systematic review and meta-analysis. Ann Surg Oncol. 19:2212–2223. 2012. View Article : Google Scholar : PubMed/NCBI
14	Brown G, Richards CJ, Bourne MW, Newcombe RG, Radcliffe AG, Dallimore NS and Williams GT: Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology. 227:371–377. 2003. View Article : Google Scholar : PubMed/NCBI
15	Akasu T, Iinuma G, Takawa M, Yamamoto S, Muramatsu Y and Moriyama N: Accuracy of high-resolution magnetic resonance imaging in preoperative staging of rectal cancer. Ann Surg Oncol. 16:2787–2794. 2009. View Article : Google Scholar : PubMed/NCBI
16	Mizukami Y, Ueda S, Mizumoto A, Sasada T, Okumura R, Kohno S and Takabayashi A: Diffusion-weighted magnetic resonance imaging for detecting lymph node metastasis of rectal cancer. World J Surg. 35:895–899. 2011. View Article : Google Scholar : PubMed/NCBI
17	Heijnen LA, Lambregts DM, Mondal D, Martens MH, Riedl RG, Beets GL and Beets-Tan RG: Diffusion-weighted MR imaging in primary rectal cancer staging demonstrates but does not characterise lymph nodes. Eur Radiol. 23:3354–3360. 2013. View Article : Google Scholar : PubMed/NCBI
18	Choi J, Oh SN, Yeo DM, Kang WK, Jung CK, Kim SW and Park MY: Computed tomography and magnetic resonance imaging evaluation of lymph node metastasis in early colorectal cancer. World J Gastroenterol. 21:556–562. 2015. View Article : Google Scholar : PubMed/NCBI
19	Fujita S, Yamamoto S, Akasu T and Moriya Y: Risk factors of lateral pelvic lymph node metastasis in advanced rectal cancer. Int J Colorectal Dis. 24:1085–1090. 2009. View Article : Google Scholar : PubMed/NCBI