Gayet B, Frija J, Cahuzac J, Fékété F
Service de Chirurgie Digestive, Hôpital Beaujon, Clichy.
Gastroenterol Clin Biol. 1988 Jan;12(1):23-8.
Most complementary investigations assessing the resectability of esophageal carcinoma are not very accurate. In approximately half of the patients who undergo surgery, the surgeon discovers unknown growth extension of the tumor. The aim of this study was to define the place of CT scan in the assessment of esophageal cancer. A prospective study concerning 54 cases of squamous cell carcinoma was conducted during 18 months. We consecutively tested the sensitivity and the specificity of information supplied by a CGR 10000 CT scan. The reading was done by the same radiologist who was unaware of the other preoperative findings. All cases of carcinoma were proved histologically. The characteristics of the tumor itself were accurately described by CT scan. Tracheobronchial spread was correctly assessed in 96.2 p. 100 of cases; specificity was 100 p. 100. On the contrary, the sensitivity of the nodal involvement was weak (less than 55 p. 100) for the abdominal as well as the mediastinal areas. Moreover, CT scan identified 48 out of 49 patients without metastases. The results of this study did not allow to determine the value of signs of tumoral spread to the aorta, pericardium, and intra-abdominal regions and therefore CT scan can not be used to determine invasion of the pleural or peritoneal serosa. These results suggest that: a) CT scan alone is not sufficient in the assessment of patients for surgery, b) CT scan facilitates the choice of operative strategy, c) oncologic classification of non operative carcinoma, correct fields of radiation therapy, and follow-up of malignancy through chemotherapy are improved.
大多数评估食管癌可切除性的补充检查并不十分准确。在大约一半接受手术的患者中，外科医生会发现肿瘤存在未知的生长扩展情况。本研究的目的是确定CT扫描在评估食管癌中的作用。在18个月期间对54例鳞状细胞癌患者进行了一项前瞻性研究。我们连续测试了CGR 10000 CT扫描所提供信息的敏感性和特异性。由同一位对其他术前检查结果不知情的放射科医生进行阅片。所有癌症病例均经组织学证实。CT扫描能准确描述肿瘤本身的特征。在96.2%的病例中正确评估了气管支气管扩散情况；特异性为100%。相反，对于腹部和纵隔区域，淋巴结受累的敏感性较低（低于55%）。此外，CT扫描在49例无转移的患者中识别出了48例。本研究结果无法确定肿瘤向主动脉、心包和腹腔区域扩散征象的价值，因此CT扫描不能用于确定胸膜或腹膜浆膜是否受侵。这些结果表明：a）仅CT扫描不足以评估患者是否适合手术；b）CT扫描有助于手术策略的选择；c）非手术治疗的癌症的肿瘤学分类、正确的放疗范围以及通过化疗对恶性肿瘤的随访得到了改善。
