cT2期直肠癌术前MRI分期的价值
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摘要
目的探讨早期直肠癌术前磁共振成像(MRI)分期的准确性。方法回顾性分析2015年12月～2018年9月在我院行根治性手术治疗的47例分期为cT2N0-1M0期和c T2NxM0期的早期直肠癌患者,所有患者术前均行盆腔MRI检查,且在检查后2周内行根治性手术,术前均未行新辅助治疗。分析比较术后病理分期与术前MRI分期的差异。结果 MRI检查T分期准确率为53.2%,T分期低估比例为27.7%,高估比例为19.1%;中段直肠癌MRI的T分期准确率最低(38.1%);MRI检查N分期准确率为54.2%。MRI对N分期诊断的灵敏度为63.2%,特异度为20.0%。Kappa检验显示MRI的N分期和病理N分期的一致性差(κ=-0.138,P=0.477);MRI对下段直肠癌N分期准确率最低(50.0%)。结论研究结果提示MRI在鉴别早期直肠癌T2期和判断淋巴结是否转移的准确性均较低,特别是在中下段直肠癌患者,准确性更低。
Objective To investigate the accuracy of preoperative magnetic resonance imaging(MRI) staging of early rectal cancer. Methods A retrospective analysis of 47 patients with early rectal cancer staged cT2 N0-1 M0 and cT2 NxM0 who had undergone radical surgery in our hospital from December 2015 to September 2018 was conducted. All patients were given pelvic MRI before surgery, and radical surgery was conducted within 2 weeks after the examination. No neoadjuvant therapy was used before surgery. The differences between postoperative pathological staging and preoperative MRI staging were analyzed and compared. Results The accuracy of T stage was 53.2% by MRI, the T stage underestimation rate was 27.7%, and the overestimation rate was 19.1%. The accuracy of T stage in middle rectal cancer was the lowest(38.1%). The accuracy of N stage by MRI was 54.2%. The sensitivity of MRI to N-stage diagnosis was63.2% and the specificity was 20.0%. Kappa test showed poor consistency between N stage by MRI and pathological Nstage(κ=-0.138, P=0.477); The accuracy of N staging by MRI in the lower rectal cancer was the lowest(50.0%). Conclusion The results suggest that MRI has a low accuracy in identifying T2 and lymph node metastasis in early rectal cancer, especially in patients with middle and lower rectal cancer, with lower accuracy.
Objective To investigate the accuracy of preoperative magnetic resonance imaging(MRI) staging of early rectal cancer. Methods A retrospective analysis of 47 patients with early rectal cancer staged cT2 N0-1 M0 and cT2 NxM0 who had undergone radical surgery in our hospital from December 2015 to September 2018 was conducted. All patients were given pelvic MRI before surgery, and radical surgery was conducted within 2 weeks after the examination. No neoadjuvant therapy was used before surgery. The differences between postoperative pathological staging and preoperative MRI staging were analyzed and compared. Results The accuracy of T stage was 53.2% by MRI, the T stage underestimation rate was 27.7%, and the overestimation rate was 19.1%. The accuracy of T stage in middle rectal cancer was the lowest(38.1%). The accuracy of N stage by MRI was 54.2%. The sensitivity of MRI to N-stage diagnosis was63.2% and the specificity was 20.0%. Kappa test showed poor consistency between N stage by MRI and pathological Nstage(κ=-0.138, P=0.477); The accuracy of N staging by MRI in the lower rectal cancer was the lowest(50.0%). Conclusion The results suggest that MRI has a low accuracy in identifying T2 and lymph node metastasis in early rectal cancer, especially in patients with middle and lower rectal cancer, with lower accuracy.
引文
[1]中华人民共和国卫生和计划生育委员会医政医管局,中华医学会肿瘤学分会.中国结直肠癌诊疗规范(2017年版)[J].中华外科杂志,2018,56(4):241-258.
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[5]White R,Ung KA,Mathlum M.Accuracy of magnetic resonance imaging in the pre-operative staging of rectal adenocarcinoma:Experience from a regional Australian cancer center[J].Asia Pac J Clin Oncol,2013,9(4):318-323.
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[7]孙应实,张晓鹏,李晓婷,等.直肠癌高分辨率磁共振成像T分期与病理T分期的对照研究[J].中华外科杂志,2012,50(3):207-210.
[8]Laghi A,Ferri M,Catalano C,et al.Local staging of rectal cancer with MRI using a phased array body coil[J].Abdom Imaging,2002,27(4):425-431.
[9]Beets-Tan RG,Beets GL.Rectal cancer:review with emphasis on MR imaging[J].Radiology,2004,232(2):335-346.
[10]Sauer R,Becker H,Hohenberger W,et al.Preoperative versus postoperative chemoradiotherapy for rectal cancer[J].N Engl J Med,2004,351(17):1731-1740.
[11]Brown G,Richards CJ,Bourne MW,et al.Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison[J].Radiology,2003,227(2):371.
[12]Kim NK,Kim MJ,Park JK,et al.Preoperative Staging of Rectal Cancer With MRI:Accuracy and Clinical Usefulness[J].Annals of Surgical Oncology,2000,7(10):732-737.
[13]Kim JH,Beets GL,Kim MJ,et al.High-resolution MRimaging for nodal staging in rectal cancer:Are there any criteria in addition to the size?[J].Eur J Radiol,2004,52(1):78-83.
[14]Bipat S,Glas AS,Slors FJ,et al.Rectal cancer:local staging and assessment of lymph node involvement with endoluminal US,CT,and MR imaging-a meta-analysis[J].Radiology,2004,232(3):773-783.
[15]宋幸鹤,杨素行,王屹.高分辨率MRI检查诊断直肠癌淋巴结转移及分期的准确性[J].中华消化外科杂志,2017,16(8):865-873.
[16]林伟达,骆衍新.MRI在直肠癌术前分期中的准确性分析[J].中国医药导报,2017,24(28):113-116.
[17]李金晶,陆文明,茹翱,等.直肠癌术前CEUS与MRI检查对T分期的诊断效果对比观察[J].中国现代医生,2017,55(27):105-108.
[18]肖寒冰.磁共振成像(MRI)与多层螺旋CT(MSCT)对直肠癌术前分期诊断的价值[J].当代医学,2018,24(2):80-81.
[19]姚灵君,赵柳燕,颜桂明,等.磁共振成像在直肠癌术前局部分期中的应用价值[J].中国现代医生,2016,54(20):92-94.
[2]Glynne-Jones R,Wyrwicz L,Tiret E,et al.Rectal cancer:ESMO Clinical Practice Guidelines for diagnosis,treatment and follow-up[J].Ann Oncol,2018,29(Supplement_4):iv263.
[3]National Comprehensive Cancer Network.(NCCN)Clinical Practice Guidelines in Oncology.Rectal Cancer,Version3.2018[J].https://www.nccn.org/professionals/physician_gls/pdf/rectal.
[4]姚旬,宋幸鹤,王屹,等.3.0 T高分辨磁共振成像对直肠癌浸润深度的诊断价值[J].中华胃肠外科杂志,2016,19(6):668-674.
[5]White R,Ung KA,Mathlum M.Accuracy of magnetic resonance imaging in the pre-operative staging of rectal adenocarcinoma:Experience from a regional Australian cancer center[J].Asia Pac J Clin Oncol,2013,9(4):318-323.
[6]Al-Sukhni E,Milot L,Fruitman M,et al.Diagnostic accuracy of MRI for assessment of T category,lymph node metastases,and circumferential resection margin involvement in patients with rectal cancer:A systematic review and meta-analysis[J].Ann Surg Oncol,2012,19(7):2212-2223.
[7]孙应实,张晓鹏,李晓婷,等.直肠癌高分辨率磁共振成像T分期与病理T分期的对照研究[J].中华外科杂志,2012,50(3):207-210.
[8]Laghi A,Ferri M,Catalano C,et al.Local staging of rectal cancer with MRI using a phased array body coil[J].Abdom Imaging,2002,27(4):425-431.
[9]Beets-Tan RG,Beets GL.Rectal cancer:review with emphasis on MR imaging[J].Radiology,2004,232(2):335-346.
[10]Sauer R,Becker H,Hohenberger W,et al.Preoperative versus postoperative chemoradiotherapy for rectal cancer[J].N Engl J Med,2004,351(17):1731-1740.
[11]Brown G,Richards CJ,Bourne MW,et al.Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison[J].Radiology,2003,227(2):371.
[12]Kim NK,Kim MJ,Park JK,et al.Preoperative Staging of Rectal Cancer With MRI:Accuracy and Clinical Usefulness[J].Annals of Surgical Oncology,2000,7(10):732-737.
[13]Kim JH,Beets GL,Kim MJ,et al.High-resolution MRimaging for nodal staging in rectal cancer:Are there any criteria in addition to the size?[J].Eur J Radiol,2004,52(1):78-83.
[14]Bipat S,Glas AS,Slors FJ,et al.Rectal cancer:local staging and assessment of lymph node involvement with endoluminal US,CT,and MR imaging-a meta-analysis[J].Radiology,2004,232(3):773-783.
[15]宋幸鹤,杨素行,王屹.高分辨率MRI检查诊断直肠癌淋巴结转移及分期的准确性[J].中华消化外科杂志,2017,16(8):865-873.
[16]林伟达,骆衍新.MRI在直肠癌术前分期中的准确性分析[J].中国医药导报,2017,24(28):113-116.
[17]李金晶,陆文明,茹翱,等.直肠癌术前CEUS与MRI检查对T分期的诊断效果对比观察[J].中国现代医生,2017,55(27):105-108.
[18]肖寒冰.磁共振成像(MRI)与多层螺旋CT(MSCT)对直肠癌术前分期诊断的价值[J].当代医学,2018,24(2):80-81.
[19]姚灵君,赵柳燕,颜桂明,等.磁共振成像在直肠癌术前局部分期中的应用价值[J].中国现代医生,2016,54(20):92-94.