McAvoy Andrew T W, Gokul Krishnan, Chiphang Apam, Artioukh Dmitri Y
Department of Surgery, Southport and Ormskirk Hospital, Southport, United Kingdom.
Department of Radiology, Southport and Ormskirk Hospital, Southport, United Kingdom.
Eurasian J Med. 2018 Jun;50(2):67-70. doi: 10.5152/eurasianjmed.2018.17198. Epub 2018 Jun 1.
There have been recent attempts to transfer well-established principles of rectal cancer management to colonic cancer, thereby offering neoadjuvant chemotherapy to high-risk patients at least in the trial settings. Traditionally, postoperative chemotherapy is offered to patients with colonic tumors that metastasize into regional lymph nodes and have features of extramural vascular invasion (EMVI). If the same criteria are used for the selection of patients with colonic cancer for neoadjuvant chemotherapy, then their accurate preoperative detection becomes of paramount importance. The aim of the study was to establish the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the computerized tomographic (CT) assessment of lymph node involvement and EMVI in colonic cancer.
This retrospective study included 53 consecutive adult patients (35 males and 18 females; median age, 72 years) who had complete preoperative CT staging of colonic cancer followed by its surgical resection during a 12-month period from January 1, 2012, to December 31, 2012. Patients with rectal and colonic tumors presenting as an emergency who did not have complete preoperative CT imaging were excluded. Preoperative CT findings on regional lymph node status and EMVI were compared with the final histopathological staging of resected specimens calculating sensitivity, specificity, PPV, and NPV of the test.
In predicting regional lymph node metastases, CT scan had a sensitivity of 85% and a specificity of 24%. PPV was calculated as 63% and NPV as 50%. In predicting EMVI, it had a sensitivity of 69% and a specificity of 49%. PPV was 37% and NPV was 78%.
Preoperative CT scan does not allow an accurate detection of regional lymph node metastases and EMVI and has a tendency to overstage colonic cancer.
最近有人尝试将已确立的直肠癌治疗原则应用于结肠癌，从而至少在试验环境中为高危患者提供新辅助化疗。传统上，术后化疗适用于结肠肿瘤转移至区域淋巴结且具有壁外血管侵犯（EMVI）特征的患者。如果采用相同标准来选择接受新辅助化疗的结肠癌患者，那么术前准确检测就变得至关重要。本研究的目的是确定计算机断层扫描（CT）评估结肠癌淋巴结受累情况和EMVI的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
这项回顾性研究纳入了53例连续的成年患者（35例男性和18例女性；中位年龄72岁），这些患者在2012年1月1日至2012年12月31日的12个月期间接受了结肠癌术前完整的CT分期，随后进行了手术切除。将表现为急症且术前未进行完整CT成像的直肠和结肠肿瘤患者排除。将术前CT关于区域淋巴结状态和EMVI的检查结果与切除标本的最终组织病理学分期进行比较，计算该检查的敏感性、特异性、PPV和NPV。
在预测区域淋巴结转移方面，CT扫描敏感性为85%，特异性为24%。PPV计算为63%，NPV为50%。在预测EMVI方面，敏感性为69%，特异性为49%。PPV为37%，NPV为78%。
术前CT扫描无法准确检测区域淋巴结转移和EMVI，且有高估结肠癌分期的倾向。
