Institute of Radiology, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy.
General Surgery 3, Department of Surgical, Oncological and Gastroenterological Sciences-DISCOG, University of Padova, 35128 Padova, Italy.
Tomography. 2022 Apr 22;8(3):1196-1207. doi: 10.3390/tomography8030098.
Background. The aim of this study was to identify the most accurate computed-tomography (CT) dimensional criteria of loco-regional lymph nodes (LNs) for detecting nodal metastases in gastric cancer (GC) patients. Methods. Staging CTs of surgically resected GC were jointly reviewed by two radiologists, considering only loco-regional LNs with a long axis (LA) ≥ 5 mm. For each nodal group, the short axis (SA), volume and SA/LA ratio of the largest LN, the sum of the SAs of all LNs, and the mean of the SA/LA ratios were plotted in ROC curves, taking the presence/absence of metastases at histopathology for reference. On a per-patient basis, the sums of the SAs of all LNs, and the sums of the SAs, volumes, and SA/LA ratios of the largest LNs in all nodal groups were also plotted, taking the presence/absence of metastatic LNs in each patient for reference. Results. Four hundred and forty-three nodal groups were harvested during surgery from 107 patients with GC, and 173 (39.1%) were metastatic at histopathology. By nodal group, the sum of the SAs showed the best Area Under the Curve (AUC), with a sensitivity/specificity of 62.4/72.6% using Youden’s index with a >8 mm cutoff. In the per-patient analysis, the sum of the SAs of all LNs in the loco-regional nodal groups showed the best AUC with a sensitivity/specificity of 65.6%/83.7%, using Youden’s index with a >39 mm cutoff. Conclusion. In patients with GC, the sum of the SAs of all the LNs at staging CT is the best predictor among dimensional LNs criteria of both metastatic invasion of the nodal group and the presence of metastatic LNs.
本研究旨在确定最准确的计算机断层扫描（CT）局部区域淋巴结（LN）的维度标准，以检测胃癌（GC）患者的淋巴结转移。
对手术切除的 GC 进行分期 CT 检查，由两名放射科医生共同进行，仅考虑长轴（LA）≥5mm 的局部区域 LN。对于每个淋巴结组，绘制最大 LN 的短轴（SA）、体积和 SA/LA 比值、所有 LN 的 SA 总和以及 SA/LA 比值的平均值的 ROC 曲线，以组织病理学上的转移存在/不存在为参考。对于每位患者，还绘制了所有 LN 的 SA 总和、所有淋巴结组中最大 LN 的 SA、体积和 SA/LA 比值的总和，以及每位患者中转移性 LN 的存在/不存在。
从 107 例 GC 患者的手术中采集了 443 个淋巴结组，其中 173 个（39.1%）在组织病理学上为转移性。按淋巴结组计算，SA 总和的曲线下面积（AUC）最佳，采用 Youden 指数大于 8mm 的截断值，灵敏度/特异性为 62.4%/72.6%。在每位患者的分析中，局部区域淋巴结组中所有 LN 的 SA 总和的 AUC 最佳，采用 Youden 指数大于 39mm 的截断值，灵敏度/特异性为 65.6%/83.7%。
在 GC 患者中，分期 CT 上所有 LN 的 SA 总和是淋巴结组转移侵犯和转移性 LN 存在的最佳预测因子。
