{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T18:10:58Z","timestamp":1789150258955,"version":"build-2803163510"},"reference-count":18,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Preoperative prediction of lymph node metastasis (LNM) in extrahepatic cholangiocarcinoma (ECC) is crucial for surgical strategies and prognosis, as current imaging methods are insufficient. A total of 149 ECC patients who underwent curative resection were retrospectively analyzed. We measured the Coefficient of Variation (CV) of CT values, ADC of MRI, and SUVmax of PET\/CT from multiple lymph nodes. Diagnostic performance for LNM prediction was evaluated using ROC curve analysis. The CV of CT values was the most powerful independent predictor of LNM. Its AUC (0.829) was superior to MRI ADC (0.666) and PET\/CT SUVmax (0.701). The CV of CT values showed a sensitivity of 72.8%, specificity of 72.9%, and accuracy of 72.9%. In conclusion, The CV of CT values is a promising and effective parameter for preoperatively predicting LNM in ECC. This can potentially improve patient selection for neoadjuvant therapies and surgical planning.<\/jats:p>","DOI":"10.1371\/journal.pone.0357578","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:44:37Z","timestamp":1789148677000},"page":"e0357578","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["The coefficient of variation of CT values for predicting lymph node metastasis in extrahepatic cholangiocarcinoma"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1846-5987","authenticated-orcid":true,"given":"Naokazu","family":"Chiba","sequence":"first","affiliation":[{"name":"Tokyo Medical University Hachioji Medical Center","place":["Tokyo, Japan"],"department":["Department of Digestive and Transplantation Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuta","family":"Abe","sequence":"additional","affiliation":[{"name":"Keio University School of Medicine","place":["Tokyo, Japan"],"department":["Department of Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirotaka","family":"Kojima","sequence":"additional","affiliation":[{"name":"Tokyo Medical University Hachioji Medical Center","place":["Tokyo, Japan"],"department":["Department of Digestive and Transplantation Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryota","family":"Suda","sequence":"additional","affiliation":[{"name":"Tokyo Medical University Hachioji Medical Center","place":["Tokyo, Japan"],"department":["Department of Digestive and Transplantation Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Nakagawa","sequence":"additional","affiliation":[{"name":"Tokyo Medical University Hachioji Medical Center","place":["Tokyo, Japan"],"department":["Department of Digestive and Transplantation Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeto","family":"Ochiai","sequence":"additional","affiliation":[{"name":"Tokyo Medical University Hachioji Medical Center","place":["Tokyo, Japan"],"department":["Department of Digestive and Transplantation Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Gunji","sequence":"additional","affiliation":[{"name":"Tokyo Medical University Hachioji Medical Center","place":["Tokyo, Japan"],"department":["Department of Digestive and Transplantation Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toru","family":"Sano","sequence":"additional","affiliation":[{"name":"Tokyo Medical University Hachioji Medical Center","place":["Tokyo, Japan"],"department":["Department of Digestive and Transplantation Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Tabuchi","sequence":"additional","affiliation":[{"name":"Tokyo Medical University Hachioji Medical Center","place":["Tokyo, Japan"],"department":["Department of Digestive and Transplantation Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuo","family":"Ishizaki","sequence":"additional","affiliation":[{"name":"Tokyo Medical University Hachioji Medical Center","place":["Tokyo, Japan"],"department":["Department of Digestive and Transplantation Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeyuki","family":"Kawachi","sequence":"additional","affiliation":[{"name":"Tokyo Medical University Hachioji Medical Center","place":["Tokyo, Japan"],"department":["Department of Digestive and Transplantation Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"issue":"16","key":"pone.0357578.ref001","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000025635","article-title":"Analysis of metastasis and survival between extrahepatic and intrahepatic cholangiocarcinoma: A large population-based study","volume":"100","author":"P Liao","year":"2021","journal-title":"Medicine (Baltimore)"},{"issue":"2","key":"pone.0357578.ref002","doi-asserted-by":"crossref","first-page":"220","DOI":"10.3390\/cancers17020220","article-title":"Prognostic Significance of Lymph Node Ratio in Intrahepatic and Extrahepatic Cholangiocarcinomas","volume":"17","author":"A Khomiak","year":"2025","journal-title":"Cancers (Basel)"},{"issue":"9","key":"pone.0357578.ref003","doi-asserted-by":"crossref","first-page":"5502","DOI":"10.1245\/s10434-022-11931-4","article-title":"Preoperative Diagnosis of Lymph Node Metastasis of Perihilar Cholangiocarcinoma Using Diffusion-Weighted Magnetic Resonance Imaging","volume":"29","author":"I Hosokawa","year":"2022","journal-title":"Ann Surg Oncol"},{"key":"pone.0357578.ref004","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.canlet.2019.11.036","article-title":"Radiomics model of magnetic resonance imaging for predicting pathological grading and lymph node metastases of extrahepatic cholangiocarcinoma","volume":"470","author":"C Yang","year":"2020","journal-title":"Cancer Lett"},{"issue":"1","key":"pone.0357578.ref005","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s40644-025-00842-8","article-title":"To accurately predict lymph node metastasis in patients with mass-forming intrahepatic cholangiocarcinoma by using CT radiomics features of tumor habitat subregions","volume":"25","author":"P Chen","year":"2025","journal-title":"Cancer Imaging"},{"issue":"11","key":"pone.0357578.ref006","doi-asserted-by":"crossref","first-page":"6786","DOI":"10.1245\/s10434-022-12028-8","article-title":"Radiomics-Based Preoperative Prediction of Lymph Node Metastasis in Intrahepatic Cholangiocarcinoma Using Contrast-Enhanced Computed Tomography","volume":"29","author":"S Zhang","year":"2022","journal-title":"Ann Surg Oncol"},{"issue":"4","key":"pone.0357578.ref007","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1111\/j.1477-2574.2010.00280.x","article-title":"FDG-positron emission tomography\/computed tomography and standardized uptake value in the primary diagnosis and staging of hilar cholangiocarcinoma","volume":"13","author":"AT Ruys","year":"2011","journal-title":"HPB (Oxford)"},{"issue":"12","key":"pone.0357578.ref008","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.3348\/kjr.2019.0891","article-title":"Diagnostic Performance and Prognostic Relevance of FDG Positron Emission Tomography\/Computed Tomography for Patients with Extrahepatic Cholangiocarcinoma","volume":"21","author":"NH Kim","year":"2020","journal-title":"Korean J Radiol"},{"key":"pone.0357578.ref009","doi-asserted-by":"crossref","first-page":"721460","DOI":"10.3389\/fonc.2021.721460","article-title":"Deep Learning Radiomics to Predict Regional Lymph Node Staging for Hilar Cholangiocarcinoma","volume":"11","author":"Y Wang","year":"2021","journal-title":"Front Oncol"},{"issue":"6","key":"pone.0357578.ref010","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1002\/jso.21238","article-title":"The survival outcome and prognostic factors for middle and distal bile duct cancer following surgical resection","volume":"99","author":"SB Choi","year":"2009","journal-title":"J Surg Oncol"},{"issue":"3","key":"pone.0357578.ref011","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1097\/00000658-200103000-00013","article-title":"Lymph node metastasis from hilar cholangiocarcinoma: audit of 110 patients who underwent regional and paraaortic node dissection","volume":"233","author":"Y Kitagawa","year":"2001","journal-title":"Ann Surg"},{"issue":"4","key":"pone.0357578.ref012","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1002\/bjs.9752","article-title":"Prognostic impact of lymph node metastasis in distal cholangiocarcinoma","volume":"102","author":"M Kiriyama","year":"2015","journal-title":"Br J Surg"},{"issue":"22","key":"pone.0357578.ref013","doi-asserted-by":"crossref","first-page":"2396","DOI":"10.4254\/wjh.v7.i22.2396","article-title":"Liver transplantation for cholangiocarcinoma: Current status and new insights","volume":"7","author":"G Sapisoch\u00edn","year":"2015","journal-title":"World J Hepatol"},{"issue":"9","key":"pone.0357578.ref014","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1097\/RLU.0000000000000867","article-title":"Prognostic Significance of Intratumoral Metabolic Heterogeneity on 18F-FDG PET\/CT in Pathological N0 Non-Small Cell Lung Cancer","volume":"40","author":"D-H Kim","year":"2015","journal-title":"Clin Nucl Med"},{"issue":"9","key":"pone.0357578.ref015","doi-asserted-by":"crossref","first-page":"3713","DOI":"10.1007\/s00277-024-05905-7","article-title":"Coefficient of variation and texture analysis of 18F-FDG PET\/CT images for the prediction of outcome in patients with multiple myeloma","volume":"103","author":"S Pellegrino","year":"2024","journal-title":"Ann Hematol"},{"issue":"11","key":"pone.0357578.ref016","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1097\/MNM.0000000000001456","article-title":"The diagnostic value of metabolic, morphological and heterogeneous parameters of 18F-FDG PET\/CT in mediastinal lymph node metastasis of non-small cell lung cancer","volume":"42","author":"J Hua","year":"2021","journal-title":"Nucl Med Commun"},{"issue":"2","key":"pone.0357578.ref017","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1007\/s00330-023-10108-1","article-title":"Radiomics using CT images for preoperative prediction of lymph node metastasis in perihilar cholangiocarcinoma: a multi-centric study","volume":"34","author":"P-C Zhan","year":"2024","journal-title":"Eur Radiol"},{"issue":"20","key":"pone.0357578.ref018","doi-asserted-by":"crossref","first-page":"6050","DOI":"10.7150\/jca.61101","article-title":"A radiomics model that predicts lymph node status in pancreatic cancer to guide clinical decision making: A retrospective study","volume":"12","author":"X Liang","year":"2021","journal-title":"J Cancer"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0357578","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:44:40Z","timestamp":1789148680000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0357578"}},"subtitle":[],"editor":[{"given":"Carmelo","family":"Caldarella","sequence":"first","affiliation":[{"name":"Fondazione Policlinico Universitario Agostino Gemelli IRCCS","place":["ITALY"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,11]]},"references-count":18,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0357578","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,11]]}}}