Hu Yi, Zheng Bin, Fu Jian-hua, Rong Tie-hua, Yang Hong, Luo Kong-jia, Li Yong-feng, Zhu Zhi-hua
Department of Thoracic Surgery, Sun Yat-sen University, Guangzhou 510060, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2010 Mar;13(3):205-9.
To evaluate the role of endoscopic ultrasonography (EUS) and CT in the prediction of the resectability of esophageal carcinoma.
A retrospective study was carried out in 746 patients with esophageal carcinoma. These patients were divided into CT group (480 cases), EUS group (151 cases) and EUS+CT group (115 cases). Images of EUS and CT were double-blindly reviewed by radiologists. Relationship of EUS and CT images with surgical and pathological findings was examined.
Resection rates in the EUS group, CT group and EUS+CT group were 93.4%, 91.0% and 93.9%, respectively (chi(2)=1.551, P=0.484). Accuracy, sensitivity, specificity, positive predictive value and negative predictive value in the CT group were 81.7%, 87.4%, 23.3%, 92.0% and 15.4%, respectively; 94.7%, 98.6%, 40.0%, 95.9% and 66.7% in the EUS group; and 96.5%, 99.1%, 57.1%, 97.3% and 80.0% in the EUS+CT group, respectively. When assessing aortic invasion, accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 91.3%, 33.3%, 93.1%, 13.5% and 97.7%, in the CT group, respectively; 98.7%, 87.5%, 99.3%, 87.5% and 99.3% in the EUS group, respectively,and 98.3%, 85.7%, 99.1%, 85.7% and 99.1% in the EUS+CT group, respectively. In assessing tracheobronchial invasion, accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 91.3%, 20.8%, 95.0%, 17.9% and 95.8% in the CT group, respectively; 96.0%, 20.0%, 98.6%, 33.3% and 97.3% in the EUS group, respectively; and 98.3%, 66.7%, 99.1%, 66.7% and 99.1% in the EUS+CT group. Differences in assessing resectability were significant between CT group and EUS group (chi(2)=15.131, P=0.000), between CT group and EUS+CT group (chi(2)=15.662, P=0.000), and between EUS group and EUS+CT group (chi(2)=0.502, P=0.346). Differences in assessing aortic invasion were significant between CT group and EUS group (chi(2)=9.764, P=0.000), and between CT group and EUS+CT group (chi(2)=6.659, P=0.004), but were not significant between EUS group and EUS+CT group (chi(2)=0.076, P=0.581). Differences in assessing tracheobronchial invasion were significant between CT group and EUS+CT group (chi(2)=6.659, P=0.004), but were not significant between CT group and EUS group (chi(2)=3.729, P=0.034) and between EUS group and EUS+CT group (chi(2)=1.117, P=0.248).
EUS is a better procedure than CT in the prediction of the resectability and aortic invasion in esophageal carcinoma. There is limited value for EUS and CT in assessing tracheobronchial invasion. Combination of CT and EUS does not improve the prediction of resectability significantly.
评估内镜超声（EUS）和CT在预测食管癌可切除性方面的作用。
对746例食管癌患者进行回顾性研究。这些患者被分为CT组（480例）、EUS组（151例）和EUS + CT组（115例）。放射科医生对EUS和CT图像进行双盲评估。检查EUS和CT图像与手术及病理结果之间的关系。
EUS组、CT组和EUS + CT组的切除率分别为93.4%、91.0%和93.9%（χ² = 1.551，P = 0.484）。CT组的准确性、敏感性、特异性、阳性预测值和阴性预测值分别为81.7%、87.4%、23.3%、92.0%和15.4%；EUS组分别为94.7%、98.6%、40.0%、95.9%和66.7%；EUS + CT组分别为96.5%、99.1%、57.1%、97.3%和80.0%。在评估主动脉侵犯时，CT组的准确性、敏感性、特异性、阳性预测值和阴性预测值分别为91.3%、33.3%、93.1%、13.5%和97.7%；EUS组分别为98.7%、87.5%、99.3%、87.5%和99.3%；EUS + CT组分别为98.3%、85.7%、99.1%、85.7%和99.1%。在评估气管支气管侵犯时，CT组的准确性、敏感性、特异性、阳性预测值和阴性预测值分别为91.3%、20.8%、95.0%、17.9%和95.8%；EUS组分别为96.0%、20.0%、98.6%、33.3%和97.3%；EUS + CT组分别为98.3%、66.7%、99.1%、66.7%和99.1%。在评估可切除性方面，CT组与EUS组之间（χ² = 15.131，P = 0.000）、CT组与EUS + CT组之间（χ² = 15.662，P = 0.000）以及EUS组与EUS + CT组之间（χ² = 0.502，P = 0.346）差异有统计学意义。在评估主动脉侵犯方面，CT组与EUS组之间（χ² = 9.764，P = 0.000）以及CT组与EUS + CT组之间（χ² = 6.659，P = 0.004）差异有统计学意义，但EUS组与EUS + CT组之间差异无统计学意义（χ² = 0.076，P = 0.581）。在评估气管支气管侵犯方面，CT组与EUS + CT组之间差异有统计学意义（χ² = 6.659，P = 0.004），但CT组与EUS组之间（χ² = 3.729，P = 0.034）以及EUS组与EUS + CT组之间差异无统计学意义（χ² = 1.117，P = 0.248）。
在预测食管癌的可切除性和主动脉侵犯方面，EUS比CT更具优势。在评估气管支气管侵犯方面，EUS和CT的价值有限。CT与EUS联合应用并不能显著提高可切除性的预测。
