术前全腹CT检查对妇科恶性肿瘤盆、腹腔淋巴结转移的诊断价值  

Diagnostic value of preoperative whole abdominal CT in diagnosis of pelvic and celiac lymph node metastasis of gynecological malignancies

作　　者：陶加英 唐丹 郄明蓉 Tao Jiaying;Tang Dan;Qie Mingrong(Department of Obstetrics and Gynecology,Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University),Ministry of Education,West China Second University Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China)

机构地区：[1]四川大学华西第二医院妇产科、出生缺陷与相关妇儿疾病教育部重点实验室,成都610041

出　　处：《中华妇幼临床医学杂志（电子版）》2020年第3期346-350,共5页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：国家自然科学基金资助项目(81572573)。

摘　　要：目的探讨肿瘤切除术前全腹CT检查,对妇科恶性肿瘤盆、腹腔淋巴结转移的诊断价值。方法选择2018年3月1日至12月31日,于四川大学华西第二医院接受诊治的275例妇科恶性肿瘤患者为研究对象。术前,对其均进行全腹CT+增强CT检查。对CT检查结果显示淋巴结最短直径≥10 mm、淋巴结中心性坏死、淋巴结融合或成簇聚集3项中符合任意一项者,判断为有淋巴结转移。以术后切除淋巴结的组织病理学检查结果,作为诊断淋巴结转移的“金标准”。分析CT诊断妇科恶性肿瘤患者盆、腹腔淋巴结转移的敏感度、特异度、阳性预测值、阴性预测值及准确度等指标。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》。所有患者签署知情同意书。结果①275例患者中,宫颈癌患者为169例(61.5%),子宫内膜癌为67例(24.4%),卵巢癌为29例(10.5%)。②术前CT诊断妇科恶性肿瘤患者盆、腹腔淋巴结转移的敏感度为31.0%,特异度为96.6%,阳性预测值为61.9%,阴性预测值为88.6%,准确度为86.5%。③术中对患者盆、腹腔探查结果显示,86例见淋巴结肿大、变硬,其中仅21例患者的切除淋巴结,经术后组织病理学检查,被确诊为淋巴结转移;另外21例患者经术后组织病理学检查,被确诊有淋巴结转移,但术中探查时,未发现淋巴结肿大、融合等异常。结论妇科恶性肿瘤患者术前全腹CT检查,对于诊断盆、腹腔淋巴结转移的敏感度较低,特异度较高,对术前评估淋巴结转移具有一定参考价值。Objective To explore value of preoperative whole abdominal CT in diagnosis of pelvic and celiac lymph node metastasis of gynecological malignancies.Methods From March 1 to December 31,2018,a total of 275 women with gynecologic malignancies who were diagnosed and treated in West China Second University Hospital,Sichuan University,were chosen as research subjects.All patients received preoperative whole abdominal CT examination.The shortest diameter of lymph node≥10 mm,or a lymph node with central necrosis,or lymph nodes fused or clustered,were defined as lymph node metastasis.Compared with the golden standard of postsurgical pathology of resected lymph nodes,sensitivity,specificity,positive predictive value,negative predictive value and accuracy of CT for diagnosis of pelvic and celiac lymph node metastasis were analyzed.This study was in line with World Medical Association Declaration of Helsinki revised in 2013 and informed contents were obtained from all patients.Results①Among 275 patients,there were 169(61.5%)cases of cervical cancer,67(24.4%)cases of endometrial cancer and 29(10.5%)cases of ovarian cancer.②Sensitivity,specificity,positive predictive value,negative predictive value and accuracy of CT for diagnosis of pelvic and celiac lymph node metastasis were 31.0%,96.6%,61.9%,88.6%,86.5%,respectively.③According to intraoperative exploration result,pelvic and celiac lymph nodes of 86 patients were enlarged and hardened,among them only 21 patients were diagnosed as lymph node metastasis by postsurgical histopathological examination.In addition,another 21 patients with lymph node metastasis were also confirmed by histopathological examination,but enlarged or fused lymph nodes were not found by intraoperative exploration.Conclusions Diagnosis of lymph node metastasis of gynecological malignancies by preoperative whole abdominal CT,its sensitivity is low and specificity is high,and it has certain reference value for preoperative evaluation of lymph node metastasis.

关 键 词：肿瘤转移 淋巴转移 手术前期 体层摄影术 螺旋计算机 诊断 计算机辅助 生殖器肿瘤 女(雌)性 敏感性与特异性 

分 类 号：R73[医药卫生—肿瘤]