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

Abstract

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

CLC Number:

R735.37

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.

Figures/Tables 9

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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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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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