术前CT在结肠癌分期中的作用：放射科医生经验的影响。

The usefulness of preoperative CT in colon cancer staging: impact of radiologists' experience.

作者信息

Ippolito Davide, Maino Cesare, Bianco Ilaria, Drago Silvia Girolama, Piazza Raffaella, Tamini Nicolo, Nespoli Luca, Giandola Teresa, Sironi Sandro

机构信息

Department of Diagnostic Radiology, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy.

School of Medicine, University of Milano Bicocca, Via Cadore 33, 20090, Monza, MB, Italy.

出版信息

Abdom Radiol (NY). 2023 Apr;48(4):1215-1226. doi: 10.1007/s00261-023-03835-y. Epub 2023 Feb 6.

DOI:10.1007/s00261-023-03835-y

PMID:36745207

Abstract

PURPOSE

To assess the agreement between radiologists in the detection of specific features related to T- and N-stage and evaluate accuracy in colon cancer staging.

METHODS

Patients who underwent contrast-enhanced computed tomography (CECT) before surgery were enrolled and evaluated by three radiologists with different experience. Pathological data were used as the reference standard. Tumor location, presence of tumor bulging, fat stranding, lateroconal fascia invasion, enlarged vessels, axial short diameter of the biggest node, shape, enhancement pattern, intranodal necrosis, and cluster were collected. Reliability analysis was performed with κ statistics and intraclass correlation coefficients (ICCs). Logistic regressions were used to determine independent predictors associated with staging.

RESULTS

Seventy five patients were evaluated. The reliability analysis was moderate to substantial for tumor location (κ = 0.853), T staging (κ = 0.531), tumor bulging (κ = 0.478), fat stranding (κ = 0.490), lateroconal fascia invasion (κ = 0.436), enlarged vessels (κ = 0.401), the axial short diameter of the biggest node (ICC = 0.732), shape (κ = 0.484), enhancement pattern (κ = 0.431), intranodal necrosis (κ = 0.606), and cluster (κ = 0.358). For all readers, sensitivity was higher for T3 lesions (60-69%) and specificity was higher for T2 and T4 lesions (84.5-90.0% and 82.4-85.1%). The diagnostic accuracy was acceptable for all lesions and among all readers (50.7-92.1%). The lateroconal fascia invasion and enlarged vessels resulted as independent predictor factors (OR = 3.292 and OR = 2.651) for T staging, while nodes' cluster and dimension as independent predictor factors of N staging [OR = 3.798 and OR = 1.083].

CONCLUSION

Reader's experience is one of the most important factors associated with the correct classification of colon cancer. Moreover, CECT can help depict radiological features independently associated with the T and N stages.

摘要

目的

评估放射科医生在检测与T分期和N分期相关的特定特征方面的一致性，并评估结肠癌分期的准确性。

方法

纳入术前接受对比增强计算机断层扫描（CECT）的患者，并由三位经验不同的放射科医生进行评估。病理数据用作参考标准。收集肿瘤位置、肿瘤隆起情况、脂肪条索、侧锥筋膜侵犯、血管增粗、最大淋巴结的轴向短径、形状、强化方式、淋巴结内坏死及簇状情况。采用κ统计量和组内相关系数（ICC）进行可靠性分析。使用逻辑回归确定与分期相关的独立预测因素。

结果

共评估了75例患者。肿瘤位置（κ = 0.853）、T分期（κ = 0.531）、肿瘤隆起（κ = 0.478）、脂肪条索（κ = 0.490）、侧锥筋膜侵犯（κ = 0.436）、血管增粗（κ = 0.401）、最大淋巴结的轴向短径（ICC = 0.732）、形状（κ = 0.484）、强化方式（κ = 0.431）、淋巴结内坏死（κ = 0.606）及簇状情况（κ = 0.358）的可靠性分析为中等至高度一致。对于所有阅片者，T3病变的敏感性较高（60 - 69%），T2和T4病变的特异性较高（84.5 - 90.0%和82.4 - 85.1%）。所有病变及所有阅片者的诊断准确性均可接受（50.7 - 92.1%）。侧锥筋膜侵犯和血管增粗是T分期的独立预测因素（OR = 3.292和OR = 2.651），而淋巴结簇状情况和大小是N分期的独立预测因素[OR = 3.798和OR = 1.083]。