摘要
目的探讨总径线方程在胃癌区域淋巴结转移CT诊断和分期中的临床应用价值。方法搜集本院2015年1月至2016年12月172例胃癌患者的术前CT检查资料,对比手术病理结果和术后CT检查,回顾性分析短径≥2 mm的区域淋巴结的CT表现,采用诊断试验评价、受试者工作特征曲线(ROC)分析和线性相关与回归分析建立总径线方程并进行影像诊断和分期。结果胃癌患者区域淋巴结转移比例60.5%(104/172),CT检查发现短径≥2 mm的区域淋巴结总数是病理检查区域淋巴结总数的29.7%(991/3341)(相关系数r=0.264,P<0.001),是病理检查转移阳性区域淋巴结数目的1.41倍(991/705)(相关系数r=0.467,P<0.001)。以CT检查区域淋巴结短径≥6 mm为阈值,诊断转移的灵敏度66.3%,特异度75.0%,阳性预测值80.2%,阴性预测值59.3%,总符合率69.8%,约登指数为0.413,ROC曲线下面积为0.730,P<0.001, OR值为5.914,P<0.001。未发现2 mm以上区域淋巴结的阴性预测值为100%。总径线方程y=x1+6x2(x1=短径≥2 mm且<6 mm的淋巴结数目,x2=短径≥6 mm的淋巴结数目)评估阳性区域淋巴结数目的结果与病理检查阳性淋巴结数目呈线性正相关(r=0.703,P<0.001)。数值≥6对区域淋巴结转移诊断的灵敏度为81.7%,特异度58.8%,总的符合率72.7%。以数值6~7、8~10、11~18、>18为标准对N1、N2、N3a、N3b分期评估的灵敏度分别为87.8%、86.0%、81.3%、90.0%,特异度为57.5%、59.4%、67.1%、79.8%,总符合率为77.2%、71.1%、71.1%、80.7%。结论涵盖淋巴结短径和数目而建立的总径线方程对胃癌区域淋巴结转移的影像诊断和N分期有重要的临床应用价值。
Objective Explore the clinical application of the total diameter equation in the CT diagnosis and staging of regional lymph node metastasis of gastric cancer. Methods The preoperative CT findings of 172 patients with gastric cancer diagnosed and treated in Maanshan People’s Hospital from January 2015 to December 2016 were collected. We compared the surgical pathological results and postoperative CT examination,retrospectively analyzing the CT findings of the short diameter and number of regional lymph nodes with short diameter ≥ 2 mm,using the diagnostic test evaluation,ROC curve analysis and linear correlation and regression analysis to establish the total line equation and Perform imaging diagnosis and staging. Results The proportion of regional lymph node metastasis in gastric cancer patients was 60.5%(104/172). The total number of regional lymph nodes with short diameter ≥ 2 mm was 29.7%(991/3341) in the pathological examination area,and the correlation coefficient was r=0.264,P<0.001. It was 1.41 times(991/705) of the number of lymph nodes in the pathologically positive metastatic region,and the correlation coefficient was r=0.467,P<0.001. CT scan of regional lymph node short diameter ≥ 6 mm as the threshold,the sensitivity of diagnosis metastasis was 66.3%,specificity was 75.0%,positive predictive value was 80.2%,negative predictive value was 59.3%,total coincidence rate was 69.8%,and the Yoden index was 0.413,ROC The area under the curve was 0.730,P< 0.001,and the OR value was 5.914,P< 0.001. No negative predictive value of regional lymph nodes above 2 mm was found to be 100%. Total diameter equation y=x1+6 x2(x1=number of lymph nodes with short diameter ≥2 mm and <6 mm,x2=number of lymph nodes with short diameter ≥6 mm). Numerical results of lymph node number in the positive area and number of positive lymph nodes in pathological examination had Linear positive correlation,r=0.703,P<0.001. The sensitivity of the diagnosis of regional lymph node metastasis ≥6 mm was 81.7%,the specificity was 58.8%,and the total coincidence rate was 72.7%. The sensitivity of the N1,N2,N3 a,and N3 b staging evaluations were 87.8%,86.0%,81.3%,and 90.0%,respectively and the specificity was 57.5%,based on the values ?of 6 to 7,8 to 10,11 to 18,and >18. 59.4%,67.1%,and 79.8%,the total coincidence rate was 77.2%,71.1%,71.1%,and 80.7%. Conclusion The total diameter equation established by covering the short diameter and number of lymph nodes has important clinical application value for imaging diagnosis and N stage of gastric cancer regional lymph node metastasis.
作者
金元贞
仝开军
舒荣宝
崔方博
尹毅
童贤周
JIN Yuanzhen;TONG Kaijun;SHU Rongbao(Department of Diagnostic Imaging,the People's Hospital of Maanshan,Maanshan,Anhui Province 243000,P.R.China)
出处
《临床放射学杂志》
CSCD
北大核心
2019年第11期2110-2115,共6页
Journal of Clinical Radiology
基金
安徽省马鞍山市科技计划项目(编号:YL-2014-06)
国家自然科学基金项目(编号:81502029)。
