CT对胸段食管鳞癌右喉返神经旁淋巴结转移的诊断标准及临床价值  

The diagnostic criteria and clinical value of computed tomography for right recurrent nerve nodes metastasis in squa-molls cell carcinoma of thoracic esophagus

作　　者：李振轩[1] 杨弘[1] 胡祎[1] 刘立志[1] 谢汉清 林鹏[1] 戎铁华[1] 李小东[1] 

机构地区：[1]中山大学肿瘤防治中心胸外科,广州510060

出　　处：《中华胸心血管外科杂志》2013年第11期667-670,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：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5lain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．I％；2mm层厚CT中，RRNN以短径6mm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）5rain层厚CT以右喉返神经旁最大淋巴结短径≥5rain为转移标准、2mm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，5mm层厚CT不劣于2rain层厚CT（约登指数0．538对0．506）。（3）胸上段食管癌肿瘤长度≥8cm或临床怀疑其他站有淋巴结转移为RRNN转移的高危因素。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 e- sophagus 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 suprastemal notch ： jugular group （ group A, the inferior margin of Maximum RRNN is higher than the level of su- prastemal 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 pa- tients 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 charac- teristic curve （ ROC curve） were used, the optimal operating point of RRNN short diameter for 5mm thickness layer axial ima- ges 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 nun thickness layer axial images is 6 mm, the area under the curve （SUV） is0. 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 ）

关 键 词：食管鳞癌 右喉返神经旁淋巴结 CT 诊断 

分 类 号：R735.1[医药卫生—肿瘤]