Kato T, Uehara K, Ishigaki S, Nihashi T, Arimoto A, Nakamura H, Kamiya T, Oshiro T, Ebata T, Nagino M
Division of Surgical Oncology, Department of Surgery, Nagoya University, Graduate School of Medicine, Nagoya, Japan.
Division of Surgical Oncology, Department of Surgery, Nagoya University, Graduate School of Medicine, Nagoya, Japan.
Eur J Surg Oncol. 2015 Nov;41(11):1464-70. doi: 10.1016/j.ejso.2015.08.154. Epub 2015 Aug 22.
The purpose of this study was to evaluate the diagnostic value of dual-energy computed tomography (DECT) in detecting lymph node (LN) metastasis in patients with colorectal cancer.
Data from 81 LNs from 28 patients with colorectal adenocarcinoma were retrospectively analyzed. All patients received DECT before surgery without any neoadjuvant therapy. The diagnostic value was assessed using the iodine concentration (IC).
In the pathological findings, 35 (43.2%) LNs from 13 patients were metastatic and 46 (56.8%) LNs from 17 patients were non-metastatic. The mean IC of metastatic LNs in the portal venous phase (PP) was 1.60 mg/ml, which was significantly lower compared with non-metastatic LNs (3.25 mg/ml, p < 0.001). Receiver operating characteristic (ROC) analysis revealed that the IC in PP had the highest ability to discriminate LN metastasis (area under the ROC curve [AUC] 0.932). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of IC in PP (cutoff 2.1 mg/ml) were 87.0%, 88.6%, 85.3%, 90.0%, and 87.9%, respectively. When clinically obvious metastatic LNs in conventional CT findings were excluded, 50 LNs remained (5 metastatic and 45 non-metastatic LNs). In this subgroup analysis, the IC in PP remained the most powerful predictor of metastatic LNs (cutoff: 2.1 mg/ml, AUC 0.933).
The evaluation of IC in DECT may improve the diagnostic capabilities of discriminating metastatic LNs. This method may be particularly useful when conventional CT findings lead to equivocal results.
本研究旨在评估双能计算机断层扫描（DECT）在检测结直肠癌患者淋巴结（LN）转移方面的诊断价值。
回顾性分析了28例结直肠腺癌患者的81个淋巴结的数据。所有患者在手术前均接受了DECT检查，未进行任何新辅助治疗。使用碘浓度（IC）评估诊断价值。
在病理检查结果中，13例患者的35个（43.2%）淋巴结发生转移，17例患者的46个（56.8%）淋巴结未发生转移。门静脉期（PP）转移淋巴结的平均IC为1.60mg/ml，与未转移淋巴结相比显著降低（3.25mg/ml，p<0.001）。受试者操作特征（ROC）分析显示，PP期的IC区分淋巴结转移的能力最高（ROC曲线下面积[AUC]为0.932）。PP期IC（截断值为2.1mg/ml）的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为87.0%、88.6%、85.3%、90.0%和87.9%。当排除传统CT检查结果中临床明显转移的淋巴结后，剩余50个淋巴结（5个转移淋巴结和45个未转移淋巴结）。在该亚组分析中，PP期的IC仍然是转移淋巴结最有力的预测指标（截断值：2.1mg/ml，AUC为0.933）。
DECT中IC的评估可能会提高区分转移淋巴结的诊断能力。当传统CT检查结果不明确时，该方法可能特别有用。
