摘要
目的评估64排螺旋CT在两种胃癌淋巴结分期中的价值。资料与方法搜集术前作64排螺旋CT检查且经住院手术证实的资料齐全的56例连续性胃癌病例。设定胃周和胃外淋巴结短轴径≥5mm为肿大淋巴结,由两位高年资医师独立对CT图像进行评估,对淋巴结进行计数,并分别按国际抗癌联盟(UICC)分期和日本胃癌规约(GRGCS)分期方法进行分期。评价在不同分期条件下,64排螺旋CT术前对胃癌肿大淋巴结的诊断准确性的差异。结果56例胃癌,手术共清除淋巴结322枚,短轴径≥5mm的淋巴结共计256枚,其中转移为阳性的淋巴结210枚;64排螺旋CT扫描对全部短轴径≥5mm的淋巴结的显示率为94%(240/256),检测出的阳性淋巴结百分率为95%(200/210)。对于胃壁旁组和血管旁组的肿大淋巴结,CT显示率和准确率较高。N分期的总体准确性,采用GRGCS方法为80%,UICC方法为77%。其中过高分期在GRGCS方法中的发生率为14%(8/56),在UICC方法中的发生率为9%(5/56);过低分期在GRGCS方法中的发生率为6%(3/56),在UICC方法中的发生率为14%(8/56)。两种N分期方法之间差异无统计学意义(P>0.05)。结论64排螺旋CT能够较为全面和准确地观察胃癌淋巴结的位置、形态和大小,对于N分期的总体准确性较高,采用GRGCS和UICC分期并无差异。
Objective To evaluate the efficacy of 64 row helical CT to detect metastatic lymph nodes in patients with gastric cancer. Materials and Methods From June 2006 to January 2007,56 consecutive patients diagnosed as gastric cancer were examined with a 64 row helical CT scanner before surgery at West China Hospital. Two radiologists independ- ently evaluated the N staging on the CT images. Perigastric and extragastric lymph nodes were considered to be involved when the short axial diameter was ≥5 mm. The UICC and GRGCS classification were independently applied. Differences in staging accuracy for N staging were assessed using the McNemar test, P-value less than 0.05 was considered statistical significantion. Results Surgical pathology resultes showed 256 lymph nodes larger than 5 mm on short axial diameter, and 210 (210/256) lymph nodes confirmed metastasis. MDCT imaging showed 240(94% ) of 256 lymph nodes larger than 5 mm and 200(95% ) of 210 metastasis lymph nodes were detected. The accuracy and detection rate of CT were higher in perigastric or paravessel groups. The overall accuracy for N staging of lymph nodes involvement was 80% for GRGCS and 77% for UICC classification. Overstaging of the N stage occurred in 8 ( 14% ) of 56 cases with GRGCS and 5 (9%) of 56 cases with UICC classification,whereas understaging in 3 (6%) of 56 cases with GRGCS and 8 (14%) of 56 cases with UICC classification. The difference in staging between GRGCS and UICC was not statistically significant (P 〉 0.05). Conclusion 64-row helical CT is effective for detection of metastatic lymphadenopathy and provides no different results between GRGCS and UICC staging.
出处
《临床放射学杂志》
CSCD
北大核心
2008年第8期1060-1064,共5页
Journal of Clinical Radiology
基金
国家自然科学基金资助项目(编号:30570528)