CAJ | 학술논문

目的探讨CT对胸段食管鳞癌右喉返神经旁淋巴结(RRNN)的诊断标准及临床意义.方法筛选行螺旋CT增强扫描且未行术前放化疗的胸段食管鳞癌患者,由资深放射科医师和胸外科医师分别阅片,记录每位患者右喉返神经旁最大淋巴结的位置及大小,与术后病理结果对照.以CT片中右喉返神经旁最大淋巴结下缘与胸骨上切迹水平的相对位置为标准,将患者分为颈组(A组,在胸骨上切迹水平以上)和胸组(B组,在胸骨上切迹水平以下).结果 (1)入组患者共228例,有RRNN转移的58例中,A组39例,B组17例,2例患者未见RRNN影像,A组/(A+B)组为69.6％.(2)通过ROC曲线分析,5mm层厚CT中,RRNN以短径5 mm为诊断转移的最佳工作点,曲线下面积为0.836,敏感性为89.7％、特异性为64.1％;2 mm层厚CT中,RRNN以短径6 mm为诊断转移的最佳工作点,曲线下面积为0.833,敏感性为74.1％,特异性为76.5％.(3)RRNN是否有转移与肿瘤位置、肿瘤长度和其他站淋巴结转移有明显相关性(P =0.002,P=0.037,P=0.015),与肿瘤分化程度及肿瘤T分期无明显相关性(P =0.740,P=0.758).结论 (1)多数转移RRNN位于颈部,即胸骨上切迹水平以上.(2)5 mm层厚CT以右喉返神经旁最大淋巴结短径≥5mm为转移标准、2 mm层厚CT以右喉返神经旁最大淋巴结短径≥6mm为转移标准,可提高诊断的准确性;在对右喉返神经旁淋巴结转移的判断中,5 mm层厚CT不劣于2mm层厚CT(约登指数0.538对0.506).(3)胸上段食管癌肿瘤长度≥8 cm或临床怀疑其他站有淋巴结转移为RRNN转移的高危因素.
목적 탐토CT대흉단식관린암우후반신경방림파결(RRNN)적진단표준급림상의의.방법 사선행라선CT증강소묘차미행술전방화료적흉단식관린암환자,유자심방사과의사화흉외과의사분별열편,기록매위환자우후반신경방최대림파결적위치급대소,여술후병리결과대조.이CT편중우후반신경방최대림파결하연여흉골상절적수평적상대위치위표준,장환자분위경조(A조,재흉골상절적수평이상)화흉조(B조,재흉골상절적수평이하).결과 (1)입조환자공228례,유RRNN전이적58례중,A조39례,B조17례,2례환자미견RRNN영상,A조/(A+B)조위69.6％.(2)통과ROC곡선분석,5mm층후CT중,RRNN이단경5 mm위진단전이적최가공작점,곡선하면적위0.836,민감성위89.7％、특이성위64.1％;2 mm층후CT중,RRNN이단경6 mm위진단전이적최가공작점,곡선하면적위0.833,민감성위74.1％,특이성위76.5％.(3)RRNN시부유전이여종류위치、종류장도화기타참림파결전이유명현상관성(P =0.002,P=0.037,P=0.015),여종류분화정도급종류T분기무명현상관성(P =0.740,P=0.758).결론 (1)다수전이RRNN위우경부,즉흉골상절적수평이상.(2)5 mm층후CT이우후반신경방최대림파결단경≥5mm위전이표준、2 mm층후CT이우후반신경방최대림파결단경≥6mm위전이표준,가제고진단적준학성;재대우후반신경방림파결전이적판단중,5 mm층후CT불렬우2mm층후CT(약등지수0.538대0.506).(3)흉상단식관암종류장도≥8 cm혹림상부의기타참유림파결전이위RRNN전이적고위인소.
Objective To study The diagnostic criteria and clinical value of CT for right recurrent nerve nodes (RRNN) metastasis in squamous cell carcinoma of thoracic esophagus.Methods Patients with squamous cell carcinoma of thoracic esophagus who underwent spiral computed tomography (spiral CT) enhancement scanning in our hospital were collected,those who underwent preoperative chemotherapy or radiotherapy were excluded.Images were reviewed by a senior radiologists and a thoracic surgeon,the location and the size of the Maximum RRNN were recorded,which were compared with postoperative pathological finding.Patients were divided into two group by the relative position of the inferior margin of Maximum RRNN and the level of suprasternal notch:jugular group (group A,the inferior margin of Maximum RRNN is higher than the level of suprastemal notch) and thoracic group (group B,the inferior margin of Maximum RRNN is lower than the level of suprastemal notch).Results (1) A total of 228 consecutive patients were recruited,there were 58 patients had metastatic RRNN.39 patients with metastatic RRNN belong to group A,17 patients with metastatic RRNN belong to group B,and two patients have no lymph node found in spiral CT images,the ratio between group A and group (A + B) is 69.6％.(2) Receiver operator characteristic curve (ROC curve) were used,the optimal operating point of RRNN short diameter for 5mm thickness layer axial images is 5 mm,the area under the curve(SUV) is 0.836,the sensitivity is 89.7％,and the specificity is 64.1％ ; the optimal operating point of RRNN short diameter for 2 mm thickness layer axial images is 6 mm,the area under the curve (SUV) is 0.833,the sensitivity is 74.1％,and the specificity is 76.5 ％.(3) RRNN metastasis is associated with tumor location,tumor length and other stations lymph node metastasis (P =0.002,P =0.037,P =0.015),not associated with tumor differentiation or T stage (P =0.740,P =0.758).Conclusion (1) Most metastatic RRNN located at neck,which higher than the level of suprasternal notch.(2)The optimal operating point of RRNN short diameter for 5mm thickness layer axial images is 5 mm,for 2mm thickness layer axial images is 6 mm,5mm thickness layer axial images is not worse than 2 mm(Youden index:0.538versus 0.506).(3)Upper thoracic esophageal squamous carcinoma,tumor length ≥ 8 cm and metastatic lymph nodes in other stations are risk factors of RRNN metastasis.