Wolberink Steven V R C, Beets-Tan Regina G H, de Haas-Kock Danielle F M, van de Jagt Eric J, Span Mark M, Wiggers Theo
Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
Dis Colon Rectum. 2009 May;52(5):928-34. doi: 10.1007/DCR.0b013e318194f923.
The purposes of this study were to assess whether multislice CT can identify tumors having a free or involved circumferential margin, to investigate the additional role of multislice CT as a "one-stop shopping" staging tool for staging nodal and distant metastases.
A total of 250 patients with adenocarcinoma of the rectum underwent multislice CT scans of the chest and abdomen before undergoing total mesorectal excision. The scans were scored by two teams. The main outcome was yes/no involvement of the mesorectal fascia. Histology was taken as the standard for determining the involvement.
The overall sensitivity for predicting an involved mesorectal fascia was 74.2 percent and the overall specificity was 93.9 percent. The overall sensitivity for low tumors was 65.6 percent and the overall specificity was 81.5 percent. The overall sensitivity for mid-/high rectal tumors was 76.1 percent and the overall specificity was 96.3 percent. The interobserver agreement was substantial (kappa 0.695). The overall sensitivity for the prediction of liver metastases was 64.3 percent and the overall specificity was 94.4 percent with kappa 0.82. The accuracy in predicting lymph node metastases was low.
Multislice CT can be used for the assessment of mesorectal fascia involvement in primary rectal cancer, especially those located in the middle rectum and the high rectum; however, in the prediction of an involved margin of tumors located in the distal rectum, the accuracy of multislice CT falls short.
本研究的目的是评估多层螺旋CT能否识别具有游离或受累周缘的肿瘤，探讨多层螺旋CT作为一种“一站式”分期工具在评估淋巴结和远处转移分期方面的额外作用。
250例直肠癌患者在接受全直肠系膜切除术前接受了胸部和腹部的多层螺旋CT扫描。扫描结果由两个团队评分。主要观察指标是直肠系膜筋膜是否受累。组织学检查作为确定受累情况的标准。
预测直肠系膜筋膜受累的总体敏感性为74.2%，总体特异性为93.9%。低位肿瘤的总体敏感性为65.6%，总体特异性为81.5%。中/高位直肠肿瘤的总体敏感性为76.1%，总体特异性为96.3%。观察者间一致性较高（kappa值为0.695）。预测肝转移的总体敏感性为64.3%，总体特异性为94.4%，kappa值为0.82。预测淋巴结转移的准确性较低。
多层螺旋CT可用于评估原发性直肠癌中直肠系膜筋膜的受累情况，尤其是位于直肠中部和高位的直肠癌；然而，在预测低位直肠癌肿瘤受累边缘时，多层螺旋CT的准确性不足。
