直肠腔内超声和MRI壁外血管侵犯检查对术前预测直肠癌淋巴结转移的价值  

Value of preoperative prediction of lymph node metastasis of rectal cancer by detection of extramural venous invasion by endorectal ultrasound and MRI

作　　者：王丽瑞 吴国柱 郭婧 高越 WANG Lirui;WU Guozhu;GUO Jing;GAO Yue(Graduate School of Baotou Medical College,Inner Mongolia University of Science and Technology,Inner Mongolia Baotou 014040,China;Department of Ultrasound,Inner Mongolia Autonomous Region People's Hospital,Inner Mongolia Hohhot 010017,China;Department of Imaging Medicine,Inner Mongolia Autonomous Region People's Hospital,Inner Mongolia Hohhot 010017,China;Shenzhen Mindray Bio-medical Electronics Co.,Ltd.,Guangdong Shenzhen 518057,China)

机构地区：[1]内蒙科技大学包头医学院研究生院,内蒙古包头014040 [2]内蒙古自治区人民医院超声医学科,内蒙古呼和浩特010017 [3]内蒙古自治区人民医院影像医学科,内蒙古呼和浩特010017 [4]深圳迈瑞生物医疗电子股份有限公司,广东深圳518057

出　　处：《现代肿瘤医学》2024年第20期3900-3905,共6页Journal of Modern Oncology

基　　金：内蒙古自治区自然科学基金项目(编号:2021MS08034);内蒙古医学科学院公立医院科研联合基金科技项目(编号:2023GLLH0075)。

摘　　要：目的:比较直肠腔内超声(endorectal ultrasound,ERUS)和磁共振成像(magnetic resonance imaging,MRI)术前诊断壁外血管侵犯(extramural venous invasion,EMVI)与直肠癌术后区域淋巴结转移(regional lymph node metastases,RLNM)状态的相关性,探讨ERUS术前预测直肠癌RLNM的临床价值。方法:回顾性分析71例经手术证实的直肠癌患者临床及影像资料,根据淋巴结转移情况将患者分为阳性组和阴性组,分析可能影响淋巴结转移的危险因素。采用受试者工作特征曲线(ROC曲线)评价ERUS和MRI术前诊断EMVI对RLNM的预测效能,并计算ROC曲线下面积及敏感度、特异度、阳性预测值、阴性预测值和准确度。结果:病理学T分期、ERUS诊断的EMVI状态(ER-EMVI)及MRI诊断的EMVI状态(MR-EMVI)与直肠癌RLNM显著相关,经二元Logistic回归分析显示ER-EMVI和MR-EMVI是RLNM的独立危险因素。通过ROC曲线分析,ER-EMVI及MR-EMVI预测直肠癌区域淋巴结转移的AUC分别为0.663(95%CI:0.531~0.796)和0.674(95%CI:0.543~0.805),两者之间的比较差异无统计学意义(Z=0.134,P=0.893)。ERUS和MRI联合诊断EMVI中至少有一个阳性诊断时具有预测RLNM最高的敏感度和准确度(82.8%、73.2%),而两者均诊断EMVI阳性时预测RLNM的特异度最高(90.5%)。结论:ER-EMVI和MR-EMVI是RLNM的独立危险因素,ERUS可作为MRI的补充工具用于评估术前直肠癌患者的区域淋巴结转移。Objective:To compare the correlation between preoperative diagnosis of extramural venous invasion(EMVI)by endorectal ultrasound(ERUS)and magnetic resonance imaging(MRI)and postoperative regional lymph node metastatic(RLNM)status of rectal cancer,and to explore the clinical value of ERUS in predicting RLNM of rectal cancer.Methods:The clinical and imaging data of 71 patients with surgically confirmed rectal cancer were retrospectively analyzed.The patients were divided into positive and negative groups based on lymph node metastasis,and the risk factors that may affect lymph node metastasis were analyzed.The predictive efficacy of ERUS and MRI preoperative diagnostic EMVI for RLNM was evaluated using the receiver operating characteristic curve(ROC curve),and the area under the ROC curve and the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were calculated.Results:Pathologic Tstage,EMVI status diagnosed by ERUS(ER-EMVI)and EMVI status diagnosed by MRI(MR-EMVI)were significantly related to RLNM of rectal cancer.Binary logistic regression analysis showed that ER-EMVI and MR-EMVI were independent risk factors for RLNM.The ROC curve analysis demonstrated that the AUC of ER-EMVI and MR-EMVI for predicting regional lymph node metastasis in rectal cancer were 0.663(95%CI:0.531~0.796)and 0.674(95%CI:0.543~0.805),and difference between them was not statistically significant(Z=0.134,P=0.893).The combination of ERUS and MRI in the diagnosis of EMVI with at least one positive diagnosis had the highest sensitivity and accuracy in predicting RLNM(82.8%,73.2%),while the combination of both diagnoses had the highest specificity in predicting RLNM(90.5%).Conclusion:ER-EMVI and MR-EMVI are independent risk factors for RLNM,and ERUS can be used as a complementary tool to MRI for evaluating regional lymph node metastasis in preoperative rectal cancer patients.

关 键 词：直肠癌 壁外血管侵犯 淋巴结转移 直肠腔内超声 磁共振成像 

分 类 号：R735.3[医药卫生—肿瘤]