Consistency of Pathological and CT Scanning Characteristics of Subcarinal Lymph Node Metastasis from Middle and Lower Segment of Thoracic Esophageal Squamous Carcinoma
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摘要: 目的 分析胸中下段食管鳞癌隆突下淋巴结转移与CT影像学特征之间的相关性，为CT诊断提供依据。方法 选取2012—2014年间手术切除的174例胸中下段食管鳞癌患者，分析隆突下淋巴结转移与影像学CT扫描淋巴结特点的关系。结果 全组共清扫4 862枚淋巴结，平均每例清扫淋巴结（27.94±11.6）枚，转移淋巴结306枚，转移率57.47%（100/174），转移度为6.29%（306/4862）。其中，隆突下淋巴结转移率为17.24％（30/174），转移度为6.57％（44/670）。隆突下淋巴结转移与CT扫描淋巴结的短长径之比及淋巴结短径具有相关性（rs=-0.448, P<0.001; rs=0.378, P=0.002）。隆突下淋巴结转移的CT诊断与术后病理具有一致性（Kappa=0.628, P<0.001），一致率为89.66%，特异性为94.44%，敏感度为66.67%，误诊率为5.56%，漏诊率为33.33%，阳性预测值为71.43%，阴性预测值为93.15%。结论 （1）胸中下段食管鳞癌隆突下淋巴结转移与CT中淋巴结的短长径之比及淋巴结短径具有相关性；（2）术前CT扫描隆突下淋巴结转移与术后病理具有一致性。Abstract: Objective To analyze the relationship between the subcarinal lymph node metastasis from middle and lower segment of thoracic esophageal squamous carcinoma and the CT imaging characteristics, to provide certain basis for CT diagnosis. Methods We selected 174 esophageal cancer patients who received operation from 2012 to 2014, and analyzed the relationship between the status and the characteristics of lymph nodes on CT imaging examination. Results There were 4862 lymph nodes cleaned. The average of lymph nodes was (27.94±11.6)/case. Lymph node metastasis number was 306, and transfer rate was 57.47% (100/174), and transfer degree was 6.29%(306/4862). Among them, subcarinal lymph node metastasis rate was 17.24% (30/174) and transfer degree was 6.57% (44/670). The ratio of short-length diameter was related with the shortest diameter in CT(rs=-0.448, P=0.009; rs=0.378, P=0.028). It has consistency between CT diagnosis and postoperatively pathological diagnosis of subcarinal lymph node metastasis (Kappa=0.628, P<0.001). The concordance rate was 89.66%, the specificity was 94.44%, the sensitivity was only 66.67%, the misdiagnosis rate was 5.56%, the rate of missed diagnosis was 33.33%, positive predictive value was 71.43%, and negative predictive value was 93.15%. Conclusion (1)It has relationship between subcarinal lymph node metastasis and the ratio of short-length diameter and the shortest diameter in CT. (2)It has consistency between CT diagnosis and postoperatively pathological diagnosis of subcarinal lymph node metastasis.
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