Maerz L L, Deveney C W, Lopez R R, McConnell D B
Surgical Service, Veterans Affairs Medical Center, Portland, Oregon 97207.
Am J Surg. 1993 May;165(5):558-60. doi: 10.1016/s0002-9610(05)80434-9.
In order to determine the accuracy of computed tomographic (CT) scanning, CT scan results were compared with operative and pathologic findings in 45 patients with esophageal and proximal gastric malignancies. CT scans were evaluated with respect to nodal metastases, hepatic metastases, and adjacent spread. Eight patients did not undergo surgery because of advanced disease noted on the CT scan. Of the remaining 37 patients, sensitivity of CT for all 3 parameters was less than 60%, whereas the specificity was greater than 90%. The positive predictive value was greater than 90% for nodal metastases and adjacent spread and 67% for hepatic metastases. The negative predictive value was less than 40% for nodal metastases and adjacent spread and 90% for hepatic metastases. For esophageal and proximal gastric malignancies, CT is useful in identifying advanced disease and in predicting resectability. In less advanced cases, CT is not sensitive, and its negative predictive value is poor with regard to local and lymphatic spread. CT scanning is useful to stage the most advanced cases but because of limited accuracy should be combined with other diagnostic studies when accurate staging is required.
为了确定计算机断层扫描（CT）的准确性，将45例食管和近端胃癌患者的CT扫描结果与手术及病理结果进行了比较。对CT扫描的淋巴结转移、肝转移和邻近组织扩散情况进行了评估。8例患者因CT扫描显示疾病进展而未接受手术。在其余37例患者中，CT对所有3项参数的敏感性均低于60%，而特异性大于90%。淋巴结转移和邻近组织扩散的阳性预测值大于90%，肝转移的阳性预测值为67%。淋巴结转移和邻近组织扩散的阴性预测值小于40%，肝转移的阴性预测值为90%。对于食管和近端胃癌，CT有助于识别进展期疾病并预测可切除性。在不太晚期的病例中，CT不敏感，其对局部和淋巴扩散的阴性预测值较差。CT扫描有助于对最晚期病例进行分期，但由于准确性有限，在需要准确分期时应与其他诊断性检查相结合。
