CT在术前评估卵巢恶性肿瘤淋巴结转移中的价值

目的探讨全腹CT在卵巢恶性肿瘤淋巴结转移术前评估中的价值。方法对136例原发性卵巢恶性肿瘤患者术前行全腹CT检查,并对淋巴结进行评估,根据部位将淋巴结转移分为腹腔及盆腔淋巴结转移。术后淋巴结组织病理学结果作为诊断淋巴结转移的金标准。结果术前CT诊断卵巢恶性肿瘤患者盆腹腔淋巴结转移的敏感度为47.2%,特异性为67.5%,PPV为48.08%,NPV为66.7%。CT预测盆腔淋巴结转移的敏感度为36.4%、特异性为76.7%、PPV为43.2%、NPV为71.3%。CT预测腹主动脉旁淋巴结转移的敏感度为34.6%,特异性为75.8%,PPV为52.9%,NPV为59.5%。而进一步亚组分析的敏感度等指标并没有明显提高。结论应用腹部CT检查评价卵巢恶性肿瘤是否存在淋巴结转移的准确性有限,但对肿大淋巴结定位、与周围毗邻关系有参考价值。

The diagnostic significance of abdominal CT in evaluating lymph node metastasis of ovarian malignant tumor before operation

Objective To explore the value and significance of whole-abdominal CT(plain and enhanced)preoperative assessment of lymph node metastasis of ovarian malignant tumors.Methods This retrospective analysis included 136 patients with primary ovarian cancer.Preoperative CT assessment of lymph node metastasis had been divided into abdominal and pelvic metastases according to the location.Postoperative pathological examination results were used as the standard for diagnosis of lymph node metastasis.By calculating the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of CT in the diagnosis of pelvic and abdominal lymph node metastasis,we analyzed the role of CT in preoperative evaluation.Results Of all cases,52 had lymph node metastasis suggested CT and 53 were pathologically diagnosed with lymph node metastasis.In patients with ovarian malignancy,the sensitivity,specificity,PPV and NPV of lymph node metastasis diagnosed by preoperative CT were 47.2%,67.5%,48.08%and 66.7%,respectively.The accuracy of CT in predicting pelvic lymph node status was 63.4%,and the sensitivity,specificity,PPV and NPV were 36.4%,76.7%,43.2%and 71.3%,respectively.The accuracy,sensitivity,specificity,PPV,and NPV of predicting para-aortic lymph node status were 57.6%,34.6%,75.8%,52.9%,and 59.5%,correspondingly.However,the sensitivity of further subgroup analysis and other indicators did not improve significantly.Conclusion Abdominal CT has limited accuracy in detecting ovarian malignant tumors for lymph node metastasis.Critical evaluation should be performed on cases of suspected lymph node metastasis in CT before operation.However,it has reference value in deteriming lymph node and adjacent relationship.