基于美国癌症联合委员会（AJCC）第8版指南的胰腺癌术前分期磁共振成像
Magnetic resonance imaging for preoperative staging of pancreatic cancer based on the 8 edition of AJCC guidelines.
作者信息
Deng Yan, Ming Bing, Wu Jia-Long, Zhou Ting, Zhang Shi-Yong, Chen Yong, Lan Chuan, Zhang Xiao-Ming
机构信息
Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China.
Department of Radiology, Deyang People's Hospital, Deyang 618000, China.
出版信息
J Gastrointest Oncol. 2020 Apr;11(2):329-336. doi: 10.21037/jgo.2020.03.06.
BACKGROUND
Preoperative staging of pancreatic cancer determines the choice of treatment. Magnetic resonance imaging (MRI) plays an important role in preoperative staging of pancreatic cancer. The American Joint Committee on Cancer (AJCC) TNM staging system was revised to its 8 version in 2016, there has been no report correlating the 8 edition of the AJCC TNM staging with preoperative MRI examinations and pathological findings. The purpose of our study is to determine the staging accuracy and evaluate the resectability by using MRI about pancreatic cancer compared with intraoperative or pathological findings according to the 8 edition of the AJCC TNM staging system.
METHODS
One hundred thirty-two patients with a pathological diagnosis of pancreatic cancer who underwent preoperative MRI were identified. The clinical data, MRI findings and pathological findings were analyzed. Preoperative MRI staging and resectability evaluation were compared with pathological findings. The accuracy of MRI for preoperative T and N staging was evaluated, and the sensitivity, specificity and accuracy of MRI in evaluating the resectability were assessed. All the staging and resectability assessments were according to the 8 edition of the AJCC TNM staging system.
RESULTS
Analysis showed that the accuracy of MRI for evaluation of the T and N stages was 82.6% (109/132) and 74.2% (98/132), respectively. The sensitivity and specificity of MRI in assessing the resectability were 94.2% and 71.4%, respectively. Integrating the 8 edition of the AJCC TNM stage, no significant differences were identified between the preoperative MRI and pathological results for the staging of pancreatic cancer (P=0.805).
CONCLUSIONS
MRI is highly accurate for T staging and moderately accurate for N staging. MRI provides important preoperative evaluation of the stage and resectability of pancreatic cancer based on the 8 edition of the AJCC TNM staging system.
背景
胰腺癌的术前分期决定治疗方案的选择。磁共振成像（MRI）在胰腺癌术前分期中发挥着重要作用。美国癌症联合委员会（AJCC）TNM分期系统于2016年修订至第8版，目前尚无关于AJCC TNM分期第8版与术前MRI检查及病理结果相关性的报道。本研究的目的是根据AJCC TNM分期系统第8版，通过MRI确定胰腺癌的分期准确性，并与术中或病理结果相比较，评估其可切除性。
方法
纳入132例经病理诊断为胰腺癌且术前行MRI检查的患者。分析其临床资料、MRI表现及病理结果。将术前MRI分期及可切除性评估与病理结果进行比较。评估MRI对术前T和N分期的准确性，以及MRI评估可切除性的敏感性、特异性和准确性。所有分期及可切除性评估均依据AJCC TNM分期系统第8版。
结果
分析显示，MRI评估T分期和N分期的准确性分别为82.6%（109/132）和74.2%（98/132）。MRI评估可切除性的敏感性和特异性分别为94.2%和71.4%。结合AJCC TNM分期第8版，胰腺癌术前MRI分期与病理结果之间未发现显著差异（P = 0.805）。
结论
MRI对T分期高度准确，对N分期中度准确。基于AJCC TNM分期系统第8版，MRI为胰腺癌的分期及可切除性提供了重要的术前评估。
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