直肠腔内三维超声和MRI检测对中下段直肠癌患者术前T分期和环周切缘的诊断价值

doi:10.13481/j.1671-587X.20210328

吉林大学学报(医学版) ›› 2021, Vol. 47 ›› Issue (3): 753-760.doi: 10.13481/j.1671-587X.20210328

直肠腔内三维超声和MRI检测对中下段直肠癌患者术前T分期和环周切缘的诊断价值

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.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:2020-09-27 出版日期:2021-05-28 发布日期:2021-05-28
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);云南省教育厅科学研究基金项目(2019J1288)

Diagnostic values of three-dimensional transrectal ultrasound and MRI in diagnosis of T substages and circumferential resection margin of patients with middle and lower rectal cancer

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

^1.Department of Ultrasound，Cancer Hospital，Yunnan Province，Third Affiliated Hospital，Kunming Medical University，Kunming 650118，China
^2.Department of Breast Surgery，Cancer Hospital，Yunan Province，Third Affiliated Hospital，Kunming Medical University，Kunming 650118，China

Received:2020-09-27 Online:2021-05-28 Published:2021-05-28
Contact: Shicong TANG,Xiaomao LUO E-mail:tang_shicong@126.com;blueskyluoxiaomao@163.com

摘要/Abstract

摘要： 目的

比较直肠腔内三维超声（3D-ERUS）和核磁共振成像（MRI）对中下段直肠癌患者术前T分期和环周切缘的诊断效果，探讨3D-ERUS在评估中下段直肠癌患者术前T分期和环周切缘中的临床价值。

方法

收集94例经术后病理诊断为直肠癌患者的临床资料，患者术前均行3D-ERUS和盆腔MRI检查。3D-ERUS和MRI的T分期结果与病理结果的一致性比较采用Kappa检验，以灵敏度、特异度、阳性预测值（PPV）、阴性预测值（NPV）、精确率、召回率和F1评价3D-ERUS和MRI对T分期的诊断效果，比较3D-ERUS和MRI对直肠癌患者T分期和环周切缘有无受累的诊断有无差异性。

结果

3D-ERUS对直肠癌患者术前T分期的诊断结果与病理诊断结果的准确率为81.91%（Kappa=0.736，P<0.01），MRI对直肠癌患者术前T分期的诊断结果与病理诊断结果的准确率为74.47%（Kappa=0.624，P<0.01），二者比较差异无统计学意义（χ²=1.12，P=0.289）。3D-ERUS对直肠癌患者T_is期、T₁期和T₂期的灵敏度、特异度、PPV、NPV、精确率、召回率及F1均分别高于MRI。MRI对T₄期直肠癌诊断的灵敏度、特异度、PPV、NPV、精确率、召回率和F1均高于3D-ERUS。3D-ERUS和MRI评估环周切缘有无受累的准确率分别为88.30%和84.04%，二者比较差异无统计学意义（χ²=0.402，P=0.526）。

结论

3D-ERUS和MRI评估中下段直肠癌患者术前T分期和环周切缘状态准确率较高，3D-ERUS对早期直肠癌患者的T分期评估具有较高的临床价值。

关键词: 直肠肿瘤, 直肠腔内三维超声, 环周切缘, 核磁共振成像

Abstract: Objective

To compare the results of three-dimensional transrectal ultrasound （3D-ERUS） and magnetic resonance imaging （MRI） in the diagnosis of T substages and circumferential resection margin of the patients with middle and lower rectal cancer before operation，and to explore the diagnosis value of 3D-ERUS in the preoperative assessment of T substages and circumferential resection margin in the patients with middle and lower rectal cancer.

Methods

The data of 94 patients with rectal cancer confirmed by pathology were collected，and all the patients were examined by 3D-ERUS and MRI before operation. Kappa test was used to compare the consistency between the results of 3D-ERUS and MRI in the diagnosis of T substages and the pathological results.The specificity， sensitivity， positive predictive value （PPV）， negative predictive value （NPV），precision，Recall and F1 were used to evaluate the results of 3D-ERUS and MRI in the diagnosis of T substages and circumferential resection margin in the patients with middle and lower rectal cancer. The differences between 3D-ERUS and MRI in the diagnosis of T substages and circumferential resection margin in the patients with middle and lower rectal cancer were compared.

Results

The accuracies of 3D-ERUS and MRI and the pathological results in the diagnosis of T substages in the patients with middle and lower rectal cancer were 81.91%（Kappa=0.736，P<0.01）and 74.47%（Kappa=0.624，P<0.01），respectively，and there was no statistical difference in the diagnostic accuracy of T substages in the patients with middle and lower rectal cancer between the two methods（χ²=1.12，P=0.289）.The sensitivity， specificity， PPV， NPV， accuracy， recall and F1 diagnosed by 3D-ERUS in the rectal cancer patients at T_is， T₁ and T₂ stages were higher than those of MRI. The sensitivity， specificity， PPV， NPV， accuracies， recall and F1 diagnosed by MRI in the patients with rectal cancer at T₄ stage were higher than those of 3D-ERUS. The accuracies of 3D-ERUS and MRI in the diagnosis of circumferential resection margin were 88.30% and 84.04%，and there was no statistical difference in the diagnostic accuracy of circumferential resection margin in the patients with middle and lower rectal cancer between two methods（χ²=0.402，P=0.526）.

Conclusion

3D-ERUS and MRI have high accuracies in the evaluation of preoperative T substages and circumferential resection margin in the patients with middle and lower rectal cancer. 3D-ERUS has high clinical value in the evaluation of T substages of the patients with early rectal cancer.

Key words: rectal neoplasm, three-dimensional endorectal ultrasound, circumferential resection margin, magnetic resonance imaging

中图分类号:

R735.37

陈东, 李支尧, 陈海涛, 钏志睿, 张映贤, 金鑫, 唐诗聪, 罗晓茂. 直肠腔内三维超声和MRI检测对中下段直肠癌患者术前T分期和环周切缘的诊断价值[J]. 吉林大学学报(医学版), 2021, 47(3): 753-760.

Dong CHEN, Zhiyao LI, Haitao CHEN, Zhirui CHUAN, Yingxian ZHANG, Xin JIN, Shicong TANG, Xiaomao LUO. Diagnostic values of three-dimensional transrectal ultrasound and MRI in diagnosis of T substages and circumferential resection margin of patients with middle and lower rectal cancer[J]. Journal of Jilin University(Medicine Edition), 2021, 47(3): 753-760.

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参考文献

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result Pathological	3D-ERUS result					Total
result Pathological	pT_is	pT₁	pT₂	pT₃	pT₄	Total
uT_is	3	0	0	0	0	3
uT₁	1	7	1	0	0	0
uT₂	0	1	12	2	0	15
uT₃	0	0	2	16	6	24
uT₄	0	0	0	4	39	43
Total	4	8	15	22	45	94

result Pathological	MRIresult					Total
result Pathological	pT_is	pT₁	pT₂	pT₃	pT₄	Total
T_is	2	0	0	0	0	2
T₁	1	4	2	0	0	7
T₂	1	4	8	2	0	15
T₃	0	0	5	16	5	26
T₄	0	0	0	4	40	44
Total	4	8	15	22	45	94

Diagnosis method	Sensitivity	Specificity	PPV	NPV	Precision	Recall	F1
3D-ERUS
uT_is	75.00	100.00	100.00	98.90	100.00	75.00	85.71
uT₁	87.50	97.67	77.78	98.82	77.78	87.50	82.35
uT₂	80.00	96.20	80.00	96.20	80.00	80.00	80.00
uT₃	72.73	88.89	66.67	91.43	66.67	72.73	69.57
uT₄	86.67	91.84	90.70	88.24	90.70	86.67	88.64
MRI
T_is	50.00	100.00	100.00	97.83	100.00	50.00	66.67
T₁	50.00	96.51	57.14	95.40	57.14	50.00	53.33
T₂	53.33	91.14	53.33	91.14	53.33	53.33	53.33
T₃	72.73	86.11	61.54	91.18	61.54	72.73	66.67
T₄	88.89	91.84	90.91	90.00	90.91	88.89	89.89

Atem	Pathologic results		Total
Atem	CRM(－)	CRM(+)	Total
3D-ERUS
CRM(－）	83	0	83
CRM(+)	11	0	11
Total	94	0	94
MRI
CRM(－)	79	0	79
CRM(+)	15	0	15
Total	94	0	94

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直肠腔内三维超声和MRI检测对中下段直肠癌患者术前T分期和环周切缘的诊断价值

Diagnostic values of three-dimensional transrectal ultrasound and MRI in diagnosis of T substages and circumferential resection margin of patients with middle and lower rectal cancer

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