Shinohara T, Ohyama S, Yamaguchi T, Muto T, Kohno A, Kato Y, Urashima M
Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Eur J Surg Oncol. 2005 Sep;31(7):743-8. doi: 10.1016/j.ejso.2005.03.005.
To evaluate the clinical value of multidetector row computed tomography (MDCT) as a pre-operative staging tool for lymph node metastasis in patients with early gastric cancer (EGC).
In 278 consecutive patients with EGC, lymph node metastasis was evaluated pre-operatively with MDCT at a slice thickness of 2.5mm (n=57), 5.0mm (n=188), or 7.5mm (n=33).
Overall accuracy of nodal category from N0 to N3 was 86% for MDCT and 95% for operative assessment. Regarding accuracy in detecting at least one metastatic lymph node, area under curves (AUC) of receiver operating characteristics for 2.5, 5.0, and 7.5-mm slices and assessment during surgery were 0.87, 0.67 and 0.47, and 0.70, which were significantly different (P<0.0001). MDCT image with 2.5-mm could discriminate the presence of lymph node metastasis with diagnostic accuracy: sensitivity 80%; specificity 92%; positive predictive value (PPV) 50%; negative predictive value (NPV) 98%, whereas assessment during surgery was as follows: sensitivity 65%; specificity 98%; PPV 72%; and NPV 97%.
These results suggest that pre-operative assessment with MDCT using thinner slices may detect at least one lymph node metastasis as accurately as assessment during surgery for patients with EGC.
评估多排螺旋计算机断层扫描（MDCT）作为早期胃癌（EGC）患者术前淋巴结转移分期工具的临床价值。
连续纳入278例EGC患者，术前采用层厚2.5mm（n = 57）、5.0mm（n = 188）或7.5mm（n = 33）的MDCT评估淋巴结转移情况。
MDCT对N0至N3淋巴结分类的总体准确率为86%，手术评估的准确率为95%。在检测至少一个转移淋巴结的准确性方面，2.5mm、5.0mm和7.5mm层厚的MDCT图像以及手术评估的受试者操作特征曲线下面积（AUC）分别为0.87、0.67、0.47和0.70，差异有统计学意义（P < 0.0001）。2.5mm层厚的MDCT图像诊断淋巴结转移的准确性为：敏感性80%；特异性92%；阳性预测值（PPV）50%；阴性预测值（NPV）98%，而手术评估结果如下：敏感性65%；特异性98%；PPV 72%；NPV 97%。
这些结果表明，对于EGC患者，使用更薄层厚的MDCT进行术前评估检测至少一个淋巴结转移的准确性与手术评估相当。
