吉林大学学报(医学版) ›› 2021, Vol. 47 ›› Issue (2): 497-504.doi: 10.13481/j.1671-587X.20210232

• 影像学 • 上一篇    下一篇

直肠腔内三维超声对中下段直肠癌术前N分期的诊断价值

陈东1,李支尧1,陈海涛1,钏志睿1,张映贤1,金鑫1,唐诗聪2(),罗晓茂1()   

  1. 1.云南省肿瘤医院 昆明医科大学第三附属医院超声医学科,云南 昆明 650118
    2.云南省肿瘤医院 昆明医科大学第三附属医院乳腺外一科,云南 昆明 650118
  • 收稿日期:2020-10-06 出版日期:2021-03-28 发布日期:2021-03-25
  • 通讯作者: 唐诗聪,罗晓茂 E-mail:tang_shicong@126.com;blueskyluoxiaomao@163.com
  • 作者简介:陈 东(1990-),男,云南省罗平县人,住院医师,在读硕士研究生,主要从事浅表超声和腔内超声诊断方面的 研究。
  • 基金资助:
    国家自然科学基金地区项目(81960542);云南省科技厅-昆明医科大学应用基础研究联合专项资金项目(2018FE001-071);云南省教育厅科学研究基金项目(2019J1288)

Diagnostic value of three-dimensional transrectal ultrasound in preoperative N-staging of middle and lower rectal cancer

Dong CHEN1,Zhiyao LI1,Haitao CHEN1,Zhirui CHUAN1,Yingxian ZHANG1,Xin JIN1,Shicong TANG2(),Xiaomao LUO1()   

  1. 1.Department of Ultrasound,Cancer Hospital of Yunnan Province,Third Affiliated Hospital,Kunming Medical University,Kunming 650118,China
    2.Department of Breast Surgery,Cancer Hospital of Yunnan Province,Third Affiliated Hospital,Kunming Medical University,Kunming 650118,China
  • Received:2020-10-06 Online:2021-03-28 Published:2021-03-25
  • Contact: Shicong TANG,Xiaomao LUO E-mail:tang_shicong@126.com;blueskyluoxiaomao@163.com

摘要: 目的

探讨直肠腔内三维超声(3D-ERUS)对中下段直肠癌术前有无淋巴结转移和N分期的诊断价值,并分析直肠癌病灶和肠周淋巴结的超声影像与临床病理特征和淋巴结转移的关联性。

方法

选取94例术后病理均诊断为直肠癌的患者,术前均行3D-ERUS和盆腔核磁共振成像(MRI)检查。3D-ERUS和MRI诊断淋巴结转移的结果采用受试者工作特征曲线(ROC曲线)评价,3D-ERUS和MRI诊断N分期的结果采用精确率、召回率和F1评分评价,二者对有无淋巴结转移和N分期的诊断结果与病理结果之间的一致性均采用Kappa系数评价。采用χ2检验比较超声影象与临床病理特征和淋巴结转移的差异,差异有统计学意义的因素作为自变量纳入多因素Logistic回归分析。

结果

3D-ERUS诊断有无淋巴结转移的准确性为80.85%(Kappa=0.615,P<0.01),ROC曲线下面积(AUC)为0.831;MRI诊断有无淋巴结转移的准确性为70.21%(Kappa=0.415,P<0.01),AUC为0.728;二者AUC比较差异有统计学意义(Z=2.039,P=0.041),二者诊断准确性比较差异无统计学意义(χ2=2.33,P=0.126)。3D-ERUS对N分期的总体准确性为74.47%(Kappa=0.562,P<0.01),高于MRI(63.44%)(Kappa=0.394,P<0.01),二者准确性比较差异亦无统计学意义(χ2=2.17,P=0.141)。单因素分析,有4个因素有统计学意义,即病理T分期、癌胚抗 原(CEA)、分化程度和3D-ERUS术前T分期(uT-stage);多因素回归分析,病理T分期是有无淋巴结转移的主要危险因素(P<0.01),与Tis-T2期直肠癌比较,T4期[比值比(OR)=12.000,95%可信区间(CI):3.141~45.839]发生淋巴结转移的风险更高。

结论

3D-ERUS在术前诊断中下段直肠癌的N分期中具有较高临床应用价值,病理T4期的直肠癌发生肠周淋巴结转移的风险最高。

关键词: 直肠肿瘤, 直肠腔内三维超声, 核磁共振成像, N分期

Abstract: Objective

To explore the diagnosis value of three-dimensional transrectal ultrasound(3D-ERUS) in the preoperative lymph node metastasis and N-stage in middle and lower rectal cancer, and to explore the correlations between the ultrasound features and the clinicopathologic factors and lymph node metastasis of rectal cancer.

Method

A total of 94 patients with rectal cancer confirmed by pathology were selected,and all patients were examined by 3D-ERUS and magnetic resonance imaging (MRI). Receiver operating characteristic(ROC) curve was used to evaluate the results of 3D-ERUS and MRI in the diagnosis of lymph node metastasis;the precision,recall and F1 score were used to evaluate the results of 3D-ERUS and MRI in the diagnosis of N staging.Kappa coefficient was used to evaluate the consistency between the results of 3D-ERUS and MRI in the diagnosis of lymph node metastasis and N staging and the pathological results. Chi square test was used to compare the differences between the ultrasound features and clinicopathologic factors and lymph node metastasis of rectal cancer,and the factors with statistical differences were analyzed by multivariate Logistic regression.

Results

The accuracy of 3D-ERUS in the diagnosis of lymph node metastasis was 80.85%(Kappa=0.615,P<0.01), respectively, and the area under curve(AUC) was 0.831; the accuracy of MRI in the diagnosis of lymph node metastasis was 70.21%(Kappa=0.415,P<0.01),respectively, and the AUC was 0.728.The AUC of 3D-ERUS and MRI had statistical difference(Z=2.039, P=0.041),and there was no statistical difference in the accuracy of diagnosis between them(χ2=2.33,P=0.126).The overall accuracies of 3D-ERUS and MRI in distinguishing N staging were 74.47% and 63.44%,and there was no statistical difference(χ2=2.17,P=0.141). The univariate analysis results showed that the related factors of lymph node metastasis were pathological T stage,carcinoembryonic antigen(CEA), histological differentiation and 3D-ERUS T stage(uT-stage).The multivariate analysis results showed that the main risk factor of lymph node metastasis was pathological T stage(P<0.01);compared with stage Tis-T2 rectal cancer,stage T4 rectal cancer[odds ratio(OR)=12.000,95% confidence interval(CI):3.141-45.839] had the higher risk in the occurrence of lymph node metastasis.

Conclusion

3D-ERUS has high accuracy and clinical value in the preoperative diagnosis of N staging of middle and lower rectal cancer, and pathological T4 rectal cancer has the highest risk of perienteral lymph node metastasis.

Key words: rectal neoplasms, three-dimensional transrectal ultrasound, magnetic resonance imaging, N-staging

中图分类号: 

  • R735.37