Romagnuolo Joseph, Scott John, Hawes Robert H, Hoffman Brenda J, Reed Carolyn E, Aithal Guruprasad P, Breslin Niall P, Chen Robert Y M, Gumustop Bora, Hennessey Winnie, Van Velse Annette, Wallace Michael B
Division of Gastroenterology, University of Calgary, Alberta, Canada.
Gastrointest Endosc. 2002 May;55(6):648-54. doi: 10.1067/mge.2002.122650.
Conventional CT is insensitive for detection of metastatic involvement of celiac lymph nodes in esophageal cancer. Helical CT has theoretical advantages over "slice" CT in this regard, but its performance has not yet been prospectively studied.
Consecutive patients with untreated esophageal cancer were recruited after obtaining informed consent. Helical CT was performed on all patients and TNM staging was performed by a single radiologist. Subsequently, all patients underwent esophageal radial and, as needed, curvilinear array EUS with fine needle aspiration (FNA), for evaluation of celiac lymph nodes and TNM staging. Test performance characteristics with 95% confidence intervals were calculated, assuming EUS with FNA as the reference standard.
Forty-eight patients were recruited, of whom 37 (77%) were men. The mean (SD) age was 63.6 (10) years. Excluding 5 patients in whom a confirmatory FNA was not available (n = 43), helical CT identified celiac lymph nodes in 12 (28%) patients. The reference standard of EUS with FNA identified 15 (35%) patients with metastatic celiac lymph nodes, giving a sensitivity, specificity, and positive and negative predictive values for helical CT of 53% (95% CI [28%, 79%]), 86% (95% CI [73%, 99%]), 67% (95% CI [40%, 93%]), and 77% (95% CI [63%, 92%]), respectively, for assessing celiac lymph nodal involvement. The sensitivity and specificity of helical CT in detecting T4 disease were 25% (95% CI [3.8%, 46%]) and 94% (95% CI [85%, 100%]), respectively. There were 12 patients (25%; 95% CI [13%, 37%]) who were felt to have resectable disease by helical CT but had either metastatic involvement of celiac lymph nodes or T4 disease by EUS/FNA.
Despite technological advances, helical CT still appears unreliable, mainly because of insensitivity, for the identification of inoperable T4 or metastatic involvement of celiac lymph node disease in esophageal cancer.
传统CT对检测食管癌腹腔淋巴结转移不敏感。在这方面，螺旋CT较“断层”CT具有理论优势，但尚未进行前瞻性研究。
在获得知情同意后，招募未经治疗的连续食管癌患者。对所有患者进行螺旋CT检查，并由一名放射科医生进行TNM分期。随后，所有患者接受食管径向及必要时的曲线阵列超声内镜检查（EUS）并细针穿刺活检（FNA），以评估腹腔淋巴结及进行TNM分期。以EUS联合FNA作为参考标准，计算检验效能特征及95%置信区间。
共招募48例患者，其中37例（77%）为男性。平均（标准差）年龄为63.6（10）岁。排除5例未进行确诊性FNA的患者（n = 43）后，螺旋CT在12例（28%）患者中发现腹腔淋巴结。EUS联合FNA参考标准发现15例（35%）患者存在腹腔淋巴结转移，螺旋CT评估腹腔淋巴结受累的敏感度、特异度、阳性预测值和阴性预测值分别为53%（95% CI [28%, 79%]）、86%（95% CI [73%, 99%]）、67%（95% CI [40%, 93%]）和77%（95% CI [63%, 92%]）。螺旋CT检测T4期疾病的敏感度和特异度分别为25%（95% CI [3.8%, 46%]）和94%（95% CI [85%, 100%]）。12例患者（25%；95% CI [13%, 37%]）经螺旋CT评估认为疾病可切除，但经EUS/FNA检查发现存在腹腔淋巴结转移或T4期疾病。
尽管技术有所进步，但螺旋CT在识别食管癌中无法手术切除的T4期或腹腔淋巴结转移疾病方面似乎仍然不可靠，主要原因是其敏感度不足。
