Jiang Zhi-Yong, Kinami Shinichi, Nakamura Naohiko, Miyata Takashi, Fujita Hideto, Takamura Hiroyuki, Ueda Nobuhiko, Kosaka Takeo
Department of Surgical Oncology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa 920-0293, Japan.
World J Gastrointest Oncol. 2020 Apr 15;12(4):435-446. doi: 10.4251/wjgo.v12.i4.435.
The reliability of preoperative nodal diagnosis of advanced gastric cancer by multi-detector spiral computed tomography (MDCT) is still unclear.
To examine the diagnostic ability of MDCT more precisely by using data on intranodal pathological metastatic patterns.
A total of 108 patients with advanced gastric cancer who underwent MDCT and curative gastrectomy at Kanazawa Medical University Hospital were enrolled in this study. The nodal sizes measured on computed tomography (CT) images were compared with the pathology results. A receiver-operating characteristic curve was constructed, from which the critical value (CV) was calculated by using the data of the first 69 patients retrospectively. By using the CV, sensitivity and specificity were calculated with prospectively collected data from 39 consecutive patients. This enabled a more precise one-to-one correspondence of lymph nodes between CT and pathological examination by using the size data of lymph node mapping. The intranodal pathological metastatic patterns were classified into the following four types: Small nodular, peripheral, large nodular, and diffuse.
Although all the cases were clinically suspected as having metastasis, 81 had lymph node metastasis and 27 had no metastasis. The number of dissected, detected on CT, and metastatic nodes were, 4241, 897, and 801, respectively. The CV obtained from the receiver-operating characteristic was 7.6 mm for the long axis. The sensitivity was 91.4% and the specificity was 47.3% in the prospective phase. The large nodular and diffuse metastases were easy to diagnose because metastatic nodes with a large axis often exhibit these forms.
The ability of MDCT to contribute to a nodal diagnosis of advanced gastric cancer was examined prospectively with precise size data from node mapping, using a CV of 7.6 mm for the long axis that was calculated from the retrospectively collected data. The sensitivity was as high as 91%, and would be improved when referring to the enhanced patterns. However, its specificity was as low as 47%, because most of metastatic nodes in gastric cancer being small in size. The small nodular or peripheral type metastatic nodes were often small and considered difficult to diagnose.
多排螺旋计算机断层扫描（MDCT）对进展期胃癌术前淋巴结诊断的可靠性尚不清楚。
通过使用淋巴结内病理转移模式的数据更精确地检查MDCT的诊断能力。
本研究纳入了金泽医科大学医院108例接受MDCT检查及根治性胃切除术的进展期胃癌患者。将计算机断层扫描（CT）图像上测量的淋巴结大小与病理结果进行比较。构建受试者工作特征曲线，通过回顾性分析前69例患者的数据计算临界值（CV）。利用该CV，对连续39例患者的前瞻性收集数据计算敏感性和特异性。通过使用淋巴结图谱的大小数据，这使得CT与病理检查之间的淋巴结能够更精确地一一对应。淋巴结内病理转移模式分为以下四种类型：小结节型、周边型、大结节型和弥漫型。
尽管所有病例临床均怀疑有转移，但81例有淋巴结转移，27例无转移。切除的、CT检测到的和转移的淋巴结数量分别为4241个、897个和801个。受试者工作特征曲线得到的长轴CV为7.6mm。前瞻性阶段的敏感性为91.4%，特异性为47.3%。大结节型和弥漫型转移易于诊断，因为长轴较大的转移淋巴结常表现为这些形式。
利用回顾性收集数据计算的长轴CV为7.6mm的精确淋巴结图谱大小数据，前瞻性地研究了MDCT对进展期胃癌淋巴结诊断的贡献能力。敏感性高达91%，参考强化模式时会有所提高。然而，其特异性低至47%，因为胃癌中的大多数转移淋巴结体积较小。小结节型或周边型转移淋巴结通常较小，难以诊断。
