Pongpornsup Sopa, Posri Suthinee, Totanarungroj Kanyarat
Department of Diagnostic Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2012 May;95(5):704-11.
Determine diagnostic accuracy of evaluation for mediastinal invasion of esophageal cancer by multidetector computed tomography (MDCT) as compared with post-operative histopathology staging.
The present study retrospectively analyzed the 64-slice MDCT of twenty-one patient's diagnosis with esophageal cancer who received surgical treatment in Siriraj Hospital. Patients were enrolled between June 1, 2004 and Dec 31, 2009. Twenty-one CT images of chest were evaluated by two radiologists without knowing each patient's history as determined by surgical and pathology findings. Image analysis was determined for evaluating tumor location, wall appearance, findings of direct mediastinal extension. Accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were evaluated for tumor staging and nodal staging.
Concordance between the two different readers for the interpretations with a kappa coefficient to assess interobserver variation of0.2 to 0.9 suggests only slight agreement between the two readers. The overall sensitivity, specificity, PPV NPV and accuracy of CT T3 staging were 75%, 78%, 66.7%, 84.6%, and 77.3% respectively. The CT T4 staging had sensitivity 75%, specificity 85.7%, PPV 75%, NPV85.7%, and accuracy 81.8%. In N staging, NO staging from CT study had sensitivity 50%, specificity 33%, and accuracy 38%. NI staging from CT study had sensitivity 33%, specificity 50%, and accuracy 38%.
64-slice MDCT can be evaluated for mediastinal tumor invasion of esophageal cancer with high sensitivity, specificity, and accuracy. The metastatic node and reactive lymphadenopathy in esophageal cancer were equivocal to discriminating from CT findings, especially using 1 cm in diameter of short axis as cut point.
与术后组织病理学分期相比，确定多排螺旋计算机断层扫描（MDCT）对食管癌纵隔侵犯评估的诊断准确性。
本研究回顾性分析了在诗里拉吉医院接受手术治疗的21例食管癌患者的64排MDCT检查结果。患者入选时间为2004年6月1日至2009年12月31日。由两名放射科医生在不知道每位患者手术和病理结果所确定病史的情况下，对21例胸部CT图像进行评估。对图像进行分析以评估肿瘤位置、管壁表现、纵隔直接侵犯情况。对肿瘤分期和淋巴结分期评估准确性、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
两位不同阅片者解读结果的一致性，用kappa系数评估观察者间差异为0.2至0.9，表明两位阅片者之间仅有轻微一致性。CT T3分期的总体敏感性、特异性、PPV、NPV和准确性分别为75%、78%、66.7%、84.6%和77.3%。CT T4分期的敏感性为75%，特异性为85.7%，PPV为75%，NPV为85.7%，准确性为81.8%。在N分期中，CT检查的N0分期敏感性为50%，特异性为33%，准确性为38%。CT检查的N1分期敏感性为33%，特异性为50%，准确性为38%。
64排MDCT可用于评估食管癌纵隔肿瘤侵犯，具有较高的敏感性、特异性和准确性。食管癌中的转移淋巴结和反应性淋巴结病难以通过CT表现鉴别，尤其是以短轴直径1cm作为切点时。
