Tang Lei, Zhang Xiao-peng, Sun Ying-shi, Li Jie, Wang Ning, Cao Kun, Ji Jia-fu, Li Zi-yu
Department of Radiology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2008 Nov;11(6):529-32.
To explore the CT criteria for evaluating lymph node (LN) metastasis and preoperative N-staging of gastric cancer through the comparison of CT signs and surgical pathology.
Eighty-nine patients with gastric cancer underwent CT examinations before radical resections. A soft-reading method on PACS workstation was employed to evaluate the detection of LNs. The size and number of LNs were registered, and the accumulated size of LNs was calculated in every case. The pathological N-staging (pN(0-3)) was considered on the basis of pathological examination of excised specimens according to UICC TNM-staging system (6th edition, 2002). The relationships between LN metastases and CT findings were analyzed by SPSS using t test and one-way ANOVA analysis.
The distribution of maximal size, CT detection number and accumulated size were significantly different among different pN stages (P<0.01). All these 3 indicators were significantly different between LN metastasis group and non-metastasis group (P<0.01). There was no significant difference of maximal size among different pN stages in positive metastasis LNs (P>0.05), while significant difference could be found in CT detection number between pN1 and pN3 (P<0.01), pN2 and pN3 (P<0.01), and in accumulated size between pN1 and pN3 (P<0.01), pN1 and pN2 (P<0.01).
The involvement of LNs in gastric cancer and pN staging are associated with size, number, and accumulated size of CT detection. CT detection number is more valuable in the evaluation of N staging than LNs size. CT detection number combined with accumulated size of LNs can provide meaningful information for preoperative N-staging.
通过比较CT征象与手术病理结果，探讨评估胃癌淋巴结（LN）转移及术前N分期的CT标准。
89例胃癌患者在根治性切除术前接受CT检查。采用PACS工作站软读片法评估淋巴结的检出情况。记录淋巴结的大小和数量，计算每例患者淋巴结的累积大小。根据国际抗癌联盟（UICC）TNM分期系统（2002年第6版），对切除标本进行病理检查，确定病理N分期（pN(0 - 3)）。使用SPSS软件，通过t检验和单因素方差分析，分析淋巴结转移与CT表现之间的关系。
不同pN分期之间，最大径、CT检出数量及累积大小的分布存在显著差异（P<0.01）。这3项指标在淋巴结转移组与非转移组之间均有显著差异（P<0.01）。阳性转移淋巴结在不同pN分期之间最大径无显著差异（P>0.05），而在CT检出数量上，pN1与pN3之间（P<0.01）、pN2与pN3之间（P<0.01）存在显著差异；在累积大小上，pN1与pN3之间（P<0.01）、pN1与pN2之间（P<0.01）存在显著差异。
胃癌中淋巴结受累情况及pN分期与CT检出的大小、数量及累积大小相关。CT检出数量在评估N分期方面比淋巴结大小更具价值。CT检出数量与淋巴结累积大小相结合可为术前N分期提供有意义的信息。
