MSCT对胃癌转移淋巴结的诊断价值

目的 探讨MSCT对胃癌术前N分期及诊断各组转移淋巴结的准确性.方法 回顾性分析经手术病理证实的91例胃癌患者的病理和CT影像资料,术前均行统一方式低张口服水三期动态增强扫描,采用拟定的联合判断标准,对术前CT影像进行淋巴结N分期及分组,与术后病理对照,分期、分组的准确性采用Kappa一致性检验.结果 MSCT对胃癌N分期总的准确率为86.3%,N0、N1、N2、N3分期准确率为83.5%、89.0%、83.5%、89.0%;敏感性为86.5%、83.3%、50.0%、47.4%;特异性为79.5%、89.4%、89.6%、100.0%.N0与N2、N0与N3敏感性之间差异有统计学意义(P≤0.007).MSCT判断各组检出淋巴结准确率较高的为贲门左侧(No.2)、脾门旁(No.10)、胰头后(No.13)淋巴结,为98.9%;敏感性较高的为No.2、腹腔干旁(No.9)、No.10、No.13组淋巴结,为100%;特异性较高的为No.2、No.10、No.13组淋巴结,为98.9%.结论 MSCT对胃癌术前N分期及各组转移淋巴结的诊断具有较高的准确性,对胃癌术前评估、术中淋巴结清扫具有重要的指导意义.

Value of MSCT in the diagnosis of metastatic lymph nodes of gastric cancer

Objective To evaluate the accuracy of MSCT in the pre-operative N-staging and diagnosis of metastatic lymph nodes in each group of gastric cancer.Methods Pathological and CT data of 91 patients with gastric cancer proved by surgery and pathology were analyzed retrospectively.Three-phase dynamic enhancements were performed before surgery in a unified way of hypotonic oral water,N-stage and grouping of lymph nodes of the preoperative CT imaging were evaluated by using the established diagnostic criteria and then compared with the results of surgery and pathology,the accuracy of staging and grouping was analyzed by using Kappa test.Results The accuracy of MSCT diagnosing the N-staging as a whole was 86.3%.The accuracy for N0,N1,N2 and N3 was 83.5%,89.0%,83.5% and 89.0%,respectively.The sensitivity was 86.5%,83.3%,50% and 47.4%,respectively.The specificity was 79.5%,89.4%,89.6% and 100.0%, respectively.The sensitivity for N0 was statistically different from that for N2, N0 and N3(P≤0.007).The detected accuracy for the group of left side of the cardium (No.2), periphery of the splenic hilum (No.10), posterior of the pancreastic head (No.13) were higher than other groups on MSCT with the accuracyof 100%.The sensitivity for the group of No.2,periphery of the coeliac trunk(No.9),No.10,and No.13 was 100%.The specificity for the group of No.2,No.10,and No.13 was 98.9%.Conclusion Relatively high accuracy in the preoperative N-staging and diagnosis of metastatic lymph nodes in each group of gastric cancer can be obtained by MSCT, which provide reliable information for preoperative assessment and intraoperative lymph node dissections.