多层螺旋CT在进展期胃癌术前TNM分期中的应用价值

摘要

Objective To investigate the value of multi-slice spiral computed tomography(MSCT)in tumor-node-metastasis(TNM) staging of advanced gastric cancer.Methods The MSCT images of 79 patients with advanced gastric cancer were retrospectively ana-lyzed,and the location and size,invasion range,local or circumferential lymph node and remote metastasis of the gastric cancer were ob -served and compared with the pathological results.Results Compared with pathological results,the accuracy rate of MSCT scanning for T staging of gastric cancers was T2 75.0%(12/16),T3 77.8%(7/9),and T4 92.6%(50/54),respectively.The Kappa coefficient was 0.736,and the difference was statistically significant.The accuracy rate of MSCT scanning for N staging of gastric cancers were N 0 52.0%(13/25),N1 58.3%(14/24),N2 81.0%(17/21),and N3 88.9%(8/9),respectively.The Kappa coefficient was 0.543,and the difference was statistically significant.The accuracy rate of MSCT scanning for M staging of gastric cancers was 96.2%,which had a sensitivity of 81.8%and a specificity of 98.6%.Conclusions MSCT is an accurate method for tumor staging in advanced gastric cancer,which can make an ideal judgment in terms of the depth of tumor invasion,local or peripheral lymph nodes and remote metasta-sis.It also presents an important value for guiding the clinical treatment and for improving the quality of life and survival.%目的 探讨多层螺旋CT(MSCT)在进展期胃癌TNM分期中的应用价值.方法 回顾性分析79例进展期胃癌的MSCT图像资料,观察病灶位置、浸润深度、周围区域淋巴结及远处转移情况,并与病理结果对照.结果 与病理结果对照,MSCT T分期准确率分别为T275.0%(12/16)、T377.8%(7/9)、T492.6%(50/54),Kappa系数为0.736,其差异有统计学意义;N分期准确率分别为N052.0%(13/25)、N158.3%(14/24)、N281.0%(17/21)、N388.9%(8/9),Kappa系数为0.543,其差异有统计学意义;M分期准确率为96.2%,敏感性、特异性分别为81.8%、98.6%.结论 MSCT能较为准确地评估进展期胃癌,能对肿瘤浸润深度、周围淋巴结及远处转移情况做出理想地判断,对指导临床选择治疗方案,改善患者术后生存质量及生存期具有重要意义.