Ito Bunichi, Niwa Yasumasa, Ando Nobuhiro, Ohmiya Naoki, Miyahara Ryoji, Ohashi Akira, Itoh Akihiro, Hirooka Yoshiki, Goto Hidemi
Department of Gastroenterology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8550, Japan.
Eur J Radiol. 2005 Jun;54(3):377-82. doi: 10.1016/j.ejrad.2004.09.006.
The purpose of our investigation was to determine the usefulness of digital radiography (DR) for diagnosing the depth of invasion of esophageal carcinoma.
We evaluated 59 patients with esophageal carcinomas who underwent DR. During continuous DR in tangential views, the most distended image of the esophagus was chosen. Percent esophageal stenosis (PES) was based on the diameter across the lesion of maximal narrowing and the average of the normal oral and anal side diameters. The maximal thickness of the tumor was measured on sequentially prepared specimens. We evaluated whether the percent of esophageal stenosis correlated with the maximal thickness of the tumor on histologic findings. Receiver-operating characteristic (ROC) curves were constructed to establish the cut-off level for PES in diagnosing the depth of tumor invasion. Accuracies for the depth of the invasion were calculated based on PES using DR. For the accuracy rate, DR was compared with endoscopy and endoscopic ultrasonography (EUS).
There was a close correlation between PES and pathological thickness of the tumor. PES values (mean+/-S.D.) were 2.45+/-0.75% in Tis and T1a tumors, 13.3+/-10.9% in T1b tumors, 35.2+/-11.1% in T2 tumors, 55.2+/-18.1% in T3 tumors, and 86.1+/-7.5% in T4 tumors. Using the ROC analysis, 12.5, 37.5, and 44.4% were the highest cut-off values of PES for differentiating < or =T1a, < or =T1b, and < or =T2 tumors. Regarding T staging, 45 (76%) of 59 lesions were staged correctly with EUS, whereas 47 (80%) were staged correctly with DR.
DR is useful for diagnosing the depth of the invasion because esophageal stenosis calculated using DR is an objective index of tumor infiltration. The accuracy rate of the depth of invasion with DR was as good as that of EUS.
我们研究的目的是确定数字X线摄影（DR）在诊断食管癌浸润深度方面的实用性。
我们评估了59例行DR检查的食管癌患者。在切线位连续DR检查过程中，选取食管最扩张时的图像。食管狭窄百分比（PES）基于病变处最大狭窄直径与正常食管口侧和肛侧直径的平均值。在连续制备的标本上测量肿瘤的最大厚度。我们评估食管狭窄百分比与组织学检查发现的肿瘤最大厚度是否相关。构建受试者工作特征（ROC）曲线以确定诊断肿瘤浸润深度时PES的临界值。基于DR测得的PES计算浸润深度的准确率。将DR的准确率与内镜检查和内镜超声（EUS）进行比较。
PES与肿瘤的病理厚度密切相关。Tis和T1a期肿瘤的PES值（均值±标准差）为2.45±0.75%，T1b期肿瘤为13.3±10.9%，T2期肿瘤为35.2±11.1%，T3期肿瘤为55.2±18.1%，T4期肿瘤为86.1±7.5%。使用ROC分析，区分≤T1a、≤T1b和≤T2期肿瘤时，PES的最高临界值分别为12.5%、37.5%和44.4%。关于T分期，59个病变中有45个（76%）经EUS正确分期，而经DR正确分期的有47个（80%）。
DR有助于诊断浸润深度，因为用DR计算的食管狭窄是肿瘤浸润的客观指标。DR诊断浸润深度的准确率与EUS相当。
