Pericolic mesenteric lymph nodes: An aid in distinguishing diverticulitis from cancer of the colon

OBJECTIVE. This study was done to determine if the detection of pericolic lymph nodes on CT scans could be used to differentiate cancer of the colon from diverticulitis. MATERIALS AND METHODS. We retrospectively evaluated 58 CT scans from 57 patients with proven diverticulitis or cancer of the colon. The CT scans were evaluated by five board-certified radiologists who were unaware of the proven diagnosis. Consensus opinions regarding the presence and size of pericolic lymph nodes were recorded. These data were correlated with the proven diagnoses to determine the correlation between the observed findings and the type of colonic abnormality. Fisher's exact test was used to determine statistical significance. RESULTS. Lymph nodes were seen in 22 (71%) of 31 cases of colonic cancer and in four (15%) of 27 cases of diverticulitis. The lymph nodes were 0.5-2.5 cm in short-axis diameter. We saw no difference in node size for patients with colonic cancer versus patients with diverticulitis. The nodes were most commonly located along the blood vessels in the mesenteric fat. Statistical analysis showed a significant difference (p < .001) in the frequency but not in the size of nodes between the two groups of patients. The detection of nodes resulted in a diagnostic sensitivity and specificity for colonic cancer of 71% and 85%, respectively. CONCLUSION. Pericolic lymph nodes are seen much more frequently in patients with colonic cancer than in patients with diverticulitis. The detection of pericolic lymph nodes in patients suspected of having diverticulitis should raise the suspicion of underlying colonic cancer that should, in turn, prompt additional evaluation.