Imaizumi Ken, Homma Shigenori, Nishida Mutsumi, Soyama Takeshi, Shimura Ryosuke, Kudo Yusuke, Omotehara Satomi, Yokota Isao, Takagi Ryo, Matsui Hiroki, Miyaoka Yoichi, Ichikawa Nobuki, Yoshida Tadashi, Takahashi Norihiko, Taketomi Akinobu
Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Division of Laboratory and Transfusion Medicine, Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan.
Cancer Diagn Progn. 2022 Mar 3;2(2):173-183. doi: 10.21873/cdp.10092. eCollection 2022 Mar-Apr.
BACKGROUND/AIM: Although computed tomography (CT) is the standard modality for diagnosing lymph node metastasis (LNM), transabdominal ultrasonography (US) can be useful due to its high spatial resolution and use of Doppler signals to precisely analyse lymph nodes. This study aimed to evaluate the accuracy of US for lymph node assessment, establish US-based diagnostic criteria for LNM, and compare the capability of US with that of CT for the diagnosis of LNM.
This retrospective, single-institution, cohort study included patients who underwent radical surgery for clinical stage 0-III colon cancer, between March 2012 and February 2019.
Overall, 34.9% (66/189) of patients had pathological LNM. The optimal US diagnostic criteria were 1) short axis ≥7 mm and short/long ratio ≥0.75 and 2) at least two of the following: the absence of hilar echoes, expansive appearance, or peripheral/mixed vascularity by the colour Doppler and/or contrast-enhanced method. Compared to CT, US showed a higher diagnostic sensitivity (54.5% vs. 43.9%; p=0.296), higher concordance with the number of pathological LNM (correlation coefficient: US, 0.42; CT, 0.27) and pathological N diagnosis (weighted ĸ: US, 0.35; CT, 0.18), and higher sensitivity for advanced LNM, including multiple LNMs (47.4% vs. 18.4%; p=0.014) and N2 stage (27.8% vs. 5.6%; p=0.177).
US has higher sensitivity than CT for diagnosing LNM in colon cancer, along with a more accurate preoperative diagnosis of the N stage. Additionally, US may be more helpful than CT alone for preoperatively deciding the appropriateness of neoadjuvant treatment in colon cancer with advanced LNM.
背景/目的：尽管计算机断层扫描（CT）是诊断淋巴结转移（LNM）的标准方法，但经腹超声检查（US）因其高空间分辨率以及利用多普勒信号精确分析淋巴结而可能具有实用价值。本研究旨在评估超声检查对淋巴结评估的准确性，建立基于超声的LNM诊断标准，并比较超声与CT对LNM的诊断能力。
这项回顾性、单机构队列研究纳入了2012年3月至2019年2月期间因临床0-III期结肠癌接受根治性手术的患者。
总体而言，34.9%（66/189）的患者存在病理性LNM。最佳超声诊断标准为：1）短轴≥7mm且短/长比≥0.75；2）以下至少两项：门部无回声、外形膨隆或彩色多普勒和/或对比增强法显示的周边/混合血流信号。与CT相比，超声显示出更高的诊断敏感性（54.5%对43.9%；p=0.296），与病理性LNM数量的一致性更高（相关系数：超声为0.42；CT为0.27）以及与病理性N分期诊断的一致性更高（加权κ值：超声为0.35；CT为0.18），对包括多个LNM（47.4%对18.4%；p=0.014）和N2期（27.8%对5.6%；p=0.177）在内的晚期LNM的敏感性更高。
在诊断结肠癌LNM方面，超声比CT具有更高的敏感性，同时对N分期的术前诊断更准确。此外，对于术前判断晚期LNM结肠癌新辅助治疗的适宜性，超声可能比单独使用CT更有帮助。
