CT检查淋巴结短径评估胸段食管鳞癌左侧喉返神经旁淋巴结转移的应用价值  

Application value of CT examination of lymph node short diameter in evaluating left recurrent laryngeal nerve lymph node metastasis in thoracic esophageal squamous cell carcinoma

作　　者：李振轩 李小东[2] 李印 刘先本 郑燕 孙海波 宋涛 梁光辉 袁东风 邢文群 Li Zhenxuan;Li Xiaodong;Li Yin;Liu Xianben;Zheng Yan;Sun Haibo;Song Tao;Liang Guanghui;Yuan Dongfeng;Xing Wenqun(Department of Thoracic Surgery,the Affiliated Cancer Hospital of Zhengzhou University,Zhengzhou 450008,China;Department of Thoracic Surgery,Sun Yat-sen University Cancer Center,Guangzhou 510060,China;Department of Thoracic Surgery,Cancer Hospital Chinese Academy of Medical Sciences,Beijing 100021,China;Department of Imaging,the Affiliated Cancer Hospital of Zhengzhou University,Zhengzhou 450008,China)

机构地区：[1]郑州大学附属肿瘤医院胸外科,450008 [2]中山大学肿瘤防治中心胸外科,广州510060 [3]中国医学科学院肿瘤医院胸外科,北京100021 [4]郑州大学附属肿瘤医院医学影像科,450008

出　　处：《中华消化外科杂志》2021年第3期346-351,共6页Chinese Journal of Digestive Surgery

基　　金：国家临床重点专科建设项目([2011]873号)。

摘　　要：目的探讨CT检查淋巴结短径评估胸段食管鳞癌左侧喉返神经旁淋巴结转移的应用价值。方法采用回顾性描述性研究方法。收集2009年10月至2016年12月2家医疗中心收治的628例(中山大学肿瘤防治中心236例、郑州大学附属肿瘤医院392例)胸段食管鳞癌病人的临床病理资料;男462例,女166例;中位年龄为62岁,年龄范围为38~85岁。观察指标:(1)手术情况和左侧喉返神经旁淋巴结清扫及转移情况。(2)CT检查左侧喉返神经旁淋巴结短径评估术后左侧喉返神经旁淋巴结转移效能。(3)最佳截断值确定。(4)不同诊断标准的检测情况。偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示。以受试者工作特征曲线(ROC)的曲线下面积(AUC)评估检测方法的效能。约登指数最大值对应最佳截断点。结果(1)手术情况和左侧喉返神经旁淋巴结清扫及转移情况:628例病人中,572例行二野淋巴结清扫,56例行三野淋巴结清扫;408例行微创手术,220例行开放手术。628例病人中,60例发生左侧喉返神经旁淋巴结转移。628例病人共清扫左侧喉返神经旁淋巴结1666枚,其中左侧喉返神经旁淋巴结转移75枚,转移率为4.502%(75/1666)。(2)CT检查左侧喉返神经旁淋巴结短径评估术后左侧喉返神经旁淋巴结转移效能:CT检查左侧喉返神经旁淋巴结短径预测左侧喉返神经旁淋巴结转移的AUC为0.854(95%可信区间为0.792~0.916,P<0.05)。(3)最佳截断值的确定:分别以CT检查左侧喉返神经旁淋巴结短径为5、6、7、8、9、10 mm作为最佳截断值,其对应的约登指数分别为0.556、0.384、0.258、0.063、0.003。确定CT检查左侧喉返神经旁淋巴结短径5 mm为最佳截断值。(4)不同诊断标准的检测情况:分别以CT检查左侧喉返神经旁淋巴结短径≥5 mm和≥10 mm作为胸段食管鳞癌左侧喉返神经旁淋巴结转移的诊断标准,两者灵敏度、特异度、准确度、阳�Objective To investigate the application value of computed tomography(CT)examination of lymph node short diameter in evaluating left recurrent laryngeal nerve lymph node metastasis in thoracic esophageal squamous cell carcinoma.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 628 patients with thoracic esophageal squamous cell carcinoma who were admitted to 2 medical centers(236 cases in the Sun Yat-sen University Cancer Center and 392 cases in the Affiliated Cancer Hospital of Zhengzhou University)from October 2009 to December 2016 were collected.There were 462 males and 166 females,aged from 38 to 85 years,with a median age of 62 years.Observation indicators:(1)operation status,dissection and metastasis of left recurrent laryngeal nerve lymph node;(2)efficacy of CT examination of the left recurrent laryngeal nerve lymph node short diameter in evaluing postoperative lymph node metastasis;(3)determination of the optimal cut-off value;(4)examination sults using different diagnostic criteria.Measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers or percentages.The area under curve(AUC)of receiver operating characteristic curve(ROC)was used to estimate the efficiency of detection methods.The maximum value of Youden index corresponded to the optim cut-off point.Results(1)Operation status,dissection and metastasis of left recurrent laryngeal nerve lymph node:among the 628 patients,there were 572 cases undergoing two-field lymph node dissection while 56 cases undergoing three-field lymph node dissection,there were 408 cases undergoing minimally invasive surgery while 220 cases undergoing open surgery.Sixty of 628 patients had left recurrent laryngeal nerve lymph node metastasis.A total of 1666 left recurrent laryngeal nerve lymph nodes were dissected from the 628 patients,among which 75 were metastatic lymph nodes,with a metastasis rate of 4.502%(75/1666).(2)Efficacy of CT examination of the left recurrent larynge

关 键 词：食管肿瘤 喉返神经 淋巴结 转移 短径 X线计算机体层摄影术 灵敏度 诊断 

分 类 号：R735.1[医药卫生—肿瘤]