摘要
目的:分析320排螺旋CT在胃癌转移性淋巴结分期中的诊断价值。方法:收集医院收治的130例胃癌患者资料,所有患者术前均行320排螺旋CT检查,以术后病理学检查结果作为“金标准”,分析比较转移性和非转移性淋巴结扫描参数、淋巴结转移率,评价320排螺旋CT对胃癌肿瘤淋巴结及远处转移(TNM)分期的诊断价值。结果:130例患者的320排螺旋CT扫描诊断出94例淋巴结转移,共扫描淋巴结994枚,其中转移性淋巴结723枚,非转移性淋巴结271枚,漏诊7例,误诊5例;诊断36例淋巴结无转移,诊断正确29例。320排螺旋CT扫描诊断灵敏度、特异度、准确率、阳性预测值和阴性预测值分别为92.71%、85.29%、90.77%、94.68%和80.56%,与病理学检查具有较高的一致性(Kappa=0.77);转移性淋巴结长径、短径、平扫期、动脉期、平衡期强化程度值均高于非转移性淋巴结,差异有统计学意义(t=27.71,t=15.04,t=6.11,t=14.95,t=8.12;P<0.05);320排螺旋CT扫描诊断淋巴结N0期、N1期、N2期、N3a期和N3b期的准确率分别为94.12%、83.33%、86.96%、96.55%和100.00%,总准确率为90.77%,术前N分期误诊12例,分期不足7例(占58.33%),过度分期5例(占41.67%),其中N0期5例(占41.67%)误诊,均为过度分期;N1期3例(占25.00%)误诊,均为分期不足;N2期3例(占25.00%)误诊,均为分期不足,N3a期1例(占8.33%)误诊,为分期不足,N3b期无误诊。结论:320排螺旋CT在术前胃癌转移性淋巴结检查中特异度、灵敏度、准确率及分期诊断准确率均较高,具有较高的临床诊断价值。
Objective: To analyze the diagnostic value of 320-slice spiral computed tomography(CT) in the staging of metastatic lymph node of gastric cancer. Methods: The data of 130 patients with gastric cancer admitted to hospital were collected. All patients underwent 320-slice spiral CT examination before surgery, and the results of postoperatively pathological examination were used as the gold standards to analyze and compare the scan parameters and lymph node metastasis rate of metastatic and non-metastatic lymph nodes, and to evaluate the diagnostic value of 320-slice spiral CT on lymph node of tumor and the staging of TNM of gastric cancer. Results: Among of 130 patients,94 cases were confirmed as lymph node metastases by 320-slice spiral CT scan. A total of 994 lymph nodes were scanned, which included 723 metastatic lymph nodes and 271 non-metastatic lymph nodes, and 7 cases were missed diagnosis and 5 cases were misdiagnosis, and 36 cases didn’t occur lymph node metastases and the diagnoses of 29cases were correct. The diagnostic sensitivity, specificity, accuracy rate, positive predictive value and negative predictive value of 320-slice spiral CT scan were 92.71%, 85.29%, 90.77%, 94.68% and80.56%, respectively, which had higher consistency with pathological examination(Kappa value=0.77). The values of intensified degree of metastatic lymph nodes were significantly higher than those of non-metastatic lymph nodes at long diameter, short diameter, plain scan phase, arterial phase and equilibrium phase(t=27.71, t=15.04, t=6.11, t=14.95, t=8.12, P<0.05), respectively.The accuracy rates of 320-slice spiral CT scan were 94.12%, 83.33%, 86.96%, 96.55% and 100.00% in diagnosing N0stage, N1 stage, N2 stage, N3a stage and N3b stage of lymph node, respectively, and the total accuracy rate of that was 90.77%. 12 cases were misdiagnosis in preoperative N staging, including 7 cases insufficient staging(58.33%) and 5 cases excessive staging(41.67%), among which 5 cases were misdiagnosed at N0 stage(41.67%) and all of them were excessive staging. 3 cases(25.00%) were misdiagnosed at N1 stage and all of them were insufficient staging,and 3 cases(25.00%) were misdiagnosed at N2 stage and all of them were insufficient staging, and 1 case(8.33%)was misdiagnosed at N3a stage and it was insufficient staging. In addition, there was no misdiagnosis at N3b stage.Conclusion: 320-slice spiral CT has higher specificity, sensitivity, accuracy rate and staging diagnosis accuracy rate in the examination of preoperative gastric cancer metastatic lymph nodes, and it has a higher clinical application value.
作者
蒋亚兰
张越
张晓
蒋锐
蔡雪婷
JIANG Ya-lan;ZHANG Yue;ZHANG Xiao(Department of Radiology and Diagnosis,General Hospital of Western Theater of Chinese People's Liberation Army,Chengdu 610100,China)
出处
《中国医学装备》
2022年第10期28-32,共5页
China Medical Equipment
基金
四川省科技计划(2018JY05099)“多层螺旋CT在胃癌诊断及术前分期中的相关研究”。
关键词
320排螺旋CT
胃癌
转移性淋巴结
病理分期
320-slice spiral computed tomography(CT)
Gastric cancer
Metastatic lymph nodes
Pathological staging
