超声内镜结合CT扫描在食管癌临床分期中的应用

李娟

doi:10.3969/j.issn.1000-8179.2011.01.011

摘要: 目的：比较超声内镜（EUS）、 CT扫描及两者联合应用在判定胸段食管癌术前T、 N分期中的应用价值。方法： 48例可切除胸段食管癌患者术前均行EUS检查和CT扫描，同时分别进行T、 N分期，并与术后病理分期进行对照分析。结果：食管癌术前EUS检查T、 N分期的诊断准确率分别为77.1% （37/48）、 75.0% （36/48）， T1、 T2、 T3、 T4期诊断准确率分别为87.5%、 57.1%、 94.1%和100%；食管癌术前CT检查T、 N分期的诊断准确率分别为52.1% （25/48）和77.1% （37/48）， T1、 T2、 T3、 T4期诊断准确率分别为37.5%、33.3%、 81.2%和100%； EUS联合CT检查T、 N分期的诊断准确率分别为79.2% （38/48）和77.1% （37/48）。应用EUS测得淋巴结短径构建ROC曲线，曲线下面积为0.775，以淋巴结短径≥7.5mm作为阳性淋巴结的诊断界点，可能提高判断淋巴结转移的准确性。结论： EUS检查在食管癌术前分期的价值优于CT扫描，尤其对T分期诊断的准确率比较高。

Abstract: Comparison between Applications of Endoscopic Ultrasonography and ComputedTomography in Clinical Staging of Esophageal CancerJuan LI, Shuchai ZHU, Zhikun LIU, Yuxiang WANG, Wenbin SHENCorrespondence to: Shuchai ZHU, E-mail: sczhu@heinfo.netThe Third Department of Radiotheraphy, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, ChinaThis work was supported by Construction Fund of Hebei Provincial Program for Subjects with High Scholarship and Cre-ative Research Potential in Colleges and Universities (No. 200552); Hebei Provincial Tracking Project of Applied MedicalTechnology (No. GL200848)Abstract Objective: To compare the value of endoscopic ultrasonography ( EUS ), computed tomography ( CT ) andthe combined application of both technologies in deciding preoperative T and N staging of thoracic esophageal cancer.Methods: Both EUS and CT were conducted preoperatively in 48 patients with resectable thoracic esophageal cancer, withT and N staging and cross-check analysis of the clinicopathologic staging before and after surgery. Results: The T and Nstaging accuracy rates of EUS examination were 77.1% ( 37/48 ) and 75.0% ( 36/48 ), respectively ( T1 87.5%, T2 57.1%, T394.1%, T4 100% ). CT examination had T and N staging accuracy rates of 52.1% ( 25/48 ) and 77.1% ( 37/48 ), respectively( T1 37.5%, T2 33.3%, T3 81.2%, T4 100% ). Combined examination of EUS and CT showed T and N staging accuracy ratesof 79.2% ( 38/48 ) and 77.1% ( 37/48 ), respectively. The Kappa values of EUS detection in preoperative T and N stagewere 0.659 ( P = 0.000 ) and 0.486 ( P = 0.001 ), and the values of CT scanning were 0.364 ( P = 0.003 ) and 0.532 ( P =0.000 ). The results of EUS and CT combined examination for the dual staging were 0.693 ( P = 0.000 ) and 0.532 ( P =0.000 ). The consistency for CT scanning in N staging and the combined detection of CT and EUS in the T and N stagingbefore surgery were both good ( 0.4 < Kappa value < 0.7 ), but that for CT detection in preoperative T staging was poor (Kappa value < 0.4 ). EUS showed that the area under the ROC curve was 0.775 which was constructed by lymph node mi-nor axis. Examining positive lymph nodes and using a cut-off value of ≥ 7.5mm for the shortest diameter would increasethe detection accuracy of nodal metastasis. Conclusion: The diagnostic value of EUS is superior to CT scanning in preoper-ative T staging of esophageal cancer. The accuracy rate of both technologies in the preoperative diagnosis of N staging ishigh. The combined application of EUS and CT is expected to raise the diagnostic accuracy of T and N staging of esopha-geal cancer.Keywords Endoscopic ultrasonography; Esophageal cancer; Clinical staging; Computed tomography