Inspection of Perirectal Lymph Nodes by One-Step Nucleic Acid Amplification Predicts Lateral Lymph Node Metastasis in Advanced Rectal Cancer

Yuichiro Miyake, Tsunekazu Mizushima, Taishi Hata, Hidekazu Takahashi, Hiroyuki Hanada, Hiroki Shoji, Masatoshi Nomura, Naotsugu Haraguchi, Junichi Nishimura, Chu Matsuda, Ichiro Takemasa, Yuichiro Doki, Ikuhiro Maeda, Masaki Mori, Hirofumi Yamamoto

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Lateral lymph node dissection (LLND) is performed for advanced rectal cancers in Japan; however, it can cause sexual and urinary dysfunction. The incidence of lateral LN metastasis is estimated at 7–13.9%; therefore, excessive rectal surgery with LLND should be avoided, especially for prophylactic purposes. To identify the patients who require LLND, we examined metastases in perirectal LNs by using a one-step nucleic acid amplification (OSNA) assay to predict lateral LN metastases. Methods: Twenty-five patients who underwent surgery with bilateral LN dissection due to T3–T4 rectal cancers were prospectively included in this study. Twenty-two patients (88.0%) received preoperative chemotherapy. Among 1052 LNs from 25 patients (median 40 per case), 135 perirectal LNs (median 6 per patient) were divided into three pieces and analyzed by OSNA, reverse transcriptase-polymerase chain reaction for carcinoembryonic antigen mRNA, and pathological examination after surgery. These results were compared with the pathological diagnosis of lateral LNs. Results: Lateral LN metastases were present in 4 of 25 patients (16.0%). All of these patients were positive by OSNA for perirectal LN metastases. The OSNA assay had a sensitivity of 100%, specificity of 86%, positive predictive value of 57%, and negative predictive value (NPV) of 100% for predicting lateral LN metastases. Conclusions: The findings from this prospective study suggest that the OSNA assay of perirectal LNs may be useful for determining when LLND is necessary because of its high NPV, even in patients treated with preoperative chemotherapy.

Original languageEnglish
Pages (from-to)3850-3856
Number of pages7
JournalAnnals of Surgical Oncology
Volume24
Issue number13
DOIs
Publication statusPublished - Dec 1 2017

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Rectal Neoplasms
Nucleic Acids
Lymph Nodes
Neoplasm Metastasis
Lymph Node Excision
Drug Therapy
Carcinoembryonic Antigen
Reverse Transcriptase Polymerase Chain Reaction
Dissection
Japan
Prospective Studies
Sensitivity and Specificity
Messenger RNA
Incidence

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

Cite this

Inspection of Perirectal Lymph Nodes by One-Step Nucleic Acid Amplification Predicts Lateral Lymph Node Metastasis in Advanced Rectal Cancer. / Miyake, Yuichiro; Mizushima, Tsunekazu; Hata, Taishi; Takahashi, Hidekazu; Hanada, Hiroyuki; Shoji, Hiroki; Nomura, Masatoshi; Haraguchi, Naotsugu; Nishimura, Junichi; Matsuda, Chu; Takemasa, Ichiro; Doki, Yuichiro; Maeda, Ikuhiro; Mori, Masaki; Yamamoto, Hirofumi.

In: Annals of Surgical Oncology, Vol. 24, No. 13, 01.12.2017, p. 3850-3856.

Research output: Contribution to journalArticle

Miyake, Y, Mizushima, T, Hata, T, Takahashi, H, Hanada, H, Shoji, H, Nomura, M, Haraguchi, N, Nishimura, J, Matsuda, C, Takemasa, I, Doki, Y, Maeda, I, Mori, M & Yamamoto, H 2017, 'Inspection of Perirectal Lymph Nodes by One-Step Nucleic Acid Amplification Predicts Lateral Lymph Node Metastasis in Advanced Rectal Cancer', Annals of Surgical Oncology, vol. 24, no. 13, pp. 3850-3856. https://doi.org/10.1245/s10434-017-6069-y
Miyake, Yuichiro ; Mizushima, Tsunekazu ; Hata, Taishi ; Takahashi, Hidekazu ; Hanada, Hiroyuki ; Shoji, Hiroki ; Nomura, Masatoshi ; Haraguchi, Naotsugu ; Nishimura, Junichi ; Matsuda, Chu ; Takemasa, Ichiro ; Doki, Yuichiro ; Maeda, Ikuhiro ; Mori, Masaki ; Yamamoto, Hirofumi. / Inspection of Perirectal Lymph Nodes by One-Step Nucleic Acid Amplification Predicts Lateral Lymph Node Metastasis in Advanced Rectal Cancer. In: Annals of Surgical Oncology. 2017 ; Vol. 24, No. 13. pp. 3850-3856.
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title = "Inspection of Perirectal Lymph Nodes by One-Step Nucleic Acid Amplification Predicts Lateral Lymph Node Metastasis in Advanced Rectal Cancer",
abstract = "Background: Lateral lymph node dissection (LLND) is performed for advanced rectal cancers in Japan; however, it can cause sexual and urinary dysfunction. The incidence of lateral LN metastasis is estimated at 7–13.9{\%}; therefore, excessive rectal surgery with LLND should be avoided, especially for prophylactic purposes. To identify the patients who require LLND, we examined metastases in perirectal LNs by using a one-step nucleic acid amplification (OSNA) assay to predict lateral LN metastases. Methods: Twenty-five patients who underwent surgery with bilateral LN dissection due to T3–T4 rectal cancers were prospectively included in this study. Twenty-two patients (88.0{\%}) received preoperative chemotherapy. Among 1052 LNs from 25 patients (median 40 per case), 135 perirectal LNs (median 6 per patient) were divided into three pieces and analyzed by OSNA, reverse transcriptase-polymerase chain reaction for carcinoembryonic antigen mRNA, and pathological examination after surgery. These results were compared with the pathological diagnosis of lateral LNs. Results: Lateral LN metastases were present in 4 of 25 patients (16.0{\%}). All of these patients were positive by OSNA for perirectal LN metastases. The OSNA assay had a sensitivity of 100{\%}, specificity of 86{\%}, positive predictive value of 57{\%}, and negative predictive value (NPV) of 100{\%} for predicting lateral LN metastases. Conclusions: The findings from this prospective study suggest that the OSNA assay of perirectal LNs may be useful for determining when LLND is necessary because of its high NPV, even in patients treated with preoperative chemotherapy.",
author = "Yuichiro Miyake and Tsunekazu Mizushima and Taishi Hata and Hidekazu Takahashi and Hiroyuki Hanada and Hiroki Shoji and Masatoshi Nomura and Naotsugu Haraguchi and Junichi Nishimura and Chu Matsuda and Ichiro Takemasa and Yuichiro Doki and Ikuhiro Maeda and Masaki Mori and Hirofumi Yamamoto",
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T1 - Inspection of Perirectal Lymph Nodes by One-Step Nucleic Acid Amplification Predicts Lateral Lymph Node Metastasis in Advanced Rectal Cancer

AU - Miyake, Yuichiro

AU - Mizushima, Tsunekazu

AU - Hata, Taishi

AU - Takahashi, Hidekazu

AU - Hanada, Hiroyuki

AU - Shoji, Hiroki

AU - Nomura, Masatoshi

AU - Haraguchi, Naotsugu

AU - Nishimura, Junichi

AU - Matsuda, Chu

AU - Takemasa, Ichiro

AU - Doki, Yuichiro

AU - Maeda, Ikuhiro

AU - Mori, Masaki

AU - Yamamoto, Hirofumi

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background: Lateral lymph node dissection (LLND) is performed for advanced rectal cancers in Japan; however, it can cause sexual and urinary dysfunction. The incidence of lateral LN metastasis is estimated at 7–13.9%; therefore, excessive rectal surgery with LLND should be avoided, especially for prophylactic purposes. To identify the patients who require LLND, we examined metastases in perirectal LNs by using a one-step nucleic acid amplification (OSNA) assay to predict lateral LN metastases. Methods: Twenty-five patients who underwent surgery with bilateral LN dissection due to T3–T4 rectal cancers were prospectively included in this study. Twenty-two patients (88.0%) received preoperative chemotherapy. Among 1052 LNs from 25 patients (median 40 per case), 135 perirectal LNs (median 6 per patient) were divided into three pieces and analyzed by OSNA, reverse transcriptase-polymerase chain reaction for carcinoembryonic antigen mRNA, and pathological examination after surgery. These results were compared with the pathological diagnosis of lateral LNs. Results: Lateral LN metastases were present in 4 of 25 patients (16.0%). All of these patients were positive by OSNA for perirectal LN metastases. The OSNA assay had a sensitivity of 100%, specificity of 86%, positive predictive value of 57%, and negative predictive value (NPV) of 100% for predicting lateral LN metastases. Conclusions: The findings from this prospective study suggest that the OSNA assay of perirectal LNs may be useful for determining when LLND is necessary because of its high NPV, even in patients treated with preoperative chemotherapy.

AB - Background: Lateral lymph node dissection (LLND) is performed for advanced rectal cancers in Japan; however, it can cause sexual and urinary dysfunction. The incidence of lateral LN metastasis is estimated at 7–13.9%; therefore, excessive rectal surgery with LLND should be avoided, especially for prophylactic purposes. To identify the patients who require LLND, we examined metastases in perirectal LNs by using a one-step nucleic acid amplification (OSNA) assay to predict lateral LN metastases. Methods: Twenty-five patients who underwent surgery with bilateral LN dissection due to T3–T4 rectal cancers were prospectively included in this study. Twenty-two patients (88.0%) received preoperative chemotherapy. Among 1052 LNs from 25 patients (median 40 per case), 135 perirectal LNs (median 6 per patient) were divided into three pieces and analyzed by OSNA, reverse transcriptase-polymerase chain reaction for carcinoembryonic antigen mRNA, and pathological examination after surgery. These results were compared with the pathological diagnosis of lateral LNs. Results: Lateral LN metastases were present in 4 of 25 patients (16.0%). All of these patients were positive by OSNA for perirectal LN metastases. The OSNA assay had a sensitivity of 100%, specificity of 86%, positive predictive value of 57%, and negative predictive value (NPV) of 100% for predicting lateral LN metastases. Conclusions: The findings from this prospective study suggest that the OSNA assay of perirectal LNs may be useful for determining when LLND is necessary because of its high NPV, even in patients treated with preoperative chemotherapy.

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JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

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