摘要
目的探讨可切除性胸段食管鳞状细胞癌不同T分期病人胸腹部转移淋巴结CT表现及分布特征。材料与方法回顾性分析川北医学院附属医院329例经术后病理证实为胸段食管鳞状细胞癌,同时伴淋巴结转移的病人临床及影像资料,其中男225例,女104例,年龄38～82岁,平均(55.8±9.2)岁。根据原发肿瘤是否浸润肌层将病人分为2组(pT_1及p T_(2-3))。通过观察多层螺旋CT颈胸腹部淋巴结大小、密度及强化方式等综合判断淋巴结转移,采用Kappa检验对转移淋巴结的影像及病理学结果进行一致性评估,同时观察不同T分期病人转移淋巴结优势分布区域。结果329例食管鳞状细胞癌病人中,pT_1病人51例(51/329,15.5%),pT_(2-3)病人278例(278/329,84.4%)。MSCT共发现转移淋巴结967枚,其诊断胸段食管鳞状细胞癌转移淋巴结与病理结果的一致性较好(κ=0.708)。胸段食管癌病人最常发生淋巴结转移的区域为上纵隔及胃周区域。p T_1组病人中,原发肿瘤位于胸上段最常见淋巴结转移区域为上纵隔区,位于胸中、下段最易发生胃周区域淋巴结转移,中下纵隔及腹腔区域转移较少。p T_(2-3)组中,胸上中段及下段食管癌最常见淋巴结转移区域分别为上纵隔区及胃周区,而中、下纵隔淋巴结转移率较pT_1组明显增加(P<0.05)。结论多层螺旋CT扫描对评估胸段食管癌淋巴结转移有较高的准确性,且食管癌不同T分期病人的淋巴结转移区域有明显差别。
Objective To investigated the multi-slice CT（MSCT）features and distributions of thoracic-abdominal lymph node metastasis at different T stages in patients with thoracic esophageal squamous cell carcinoma（ESCC）.Material and methods A total 329 surgical proven ESCC patients associated with lymph node（LN）metastasis from Affiliated hospital of North Sichuan Medical College were enrolled,and the clinical and medical image data of all patients were retrospectively reviewed.104 of the 329 patients were women and 225 were men（age range 38-82 years and mean age 55.8±9.2 years）.These patients were divided into pT1 group（tumor limited within the submucosal layer）and pT（2-3） group（tumor invading or penetrating the muscle layer）.The metastatic LNs were evaluated by MSCT,the features including size,attenuation and enhancement pattern,and were compared with pathologic results with Kappa coefficient.The distributions of involved lymph nodes in patients with different T stage were also recorded.Results Fifty one of the 329 patients were staged as PT1 （51/329,15.5%） while 278 were staged as p T（2-3） （278/329,84.4%）.A total of 967 metastatic LNs were observed on MSCT.In patients with thoracic ESCC,the diagnosis of lymph node metastasis on MSCT had relative good accordance with pathologic result （κ=0.708）,and the LNs in upper mediastinum and perigastric area were more frequently involved.In patients with tumor limited within the submucosal layer （pT1） and located in upper esophagus,LNs were more frequently involved in the upper mediastinum,whereas tumor located in the mid and lower esophagus,LNs were more frequently involved in the peri-gastric area than in the mid-or lower mediastinum.In patients with tumor invading or penetrating the muscle layer（pT（2-3））,LNs were more involved in the upper mediastinum and peri-gastric area,and node metastasis in the mid-and lower mediastinum increased dramatically compared with p T1 group （all P〈0.05）.Conclusion The LN metastasis in thoracic ESCC could be detected with high accuracy by using MSCT,and the distribution of metastatic LNs varies according to T stage in patients with ESCC.
作者
郭丹丹
李睿
陈天武
张小明
王唯成
GUO Dandan;LI Rui;CHEN Tianwu;ZHANG Xiaoming;WANG Weicheng(Department of Radiology,Affiliated Hospital of North Sichuan Medical College,Sichuan Key Laboratory of Medical Imaging,Nanchong 637000,China)
出处
《国际医学放射学杂志》
北大核心
2018年第5期537-541,共5页
International Journal of Medical Radiology
基金
国家自然科学基金(81571645)
四川省青年科技创新研究团队专项基金(2015TD0029)
四川省省属高校科研创新团队(15TD0023)
关键词
食管鳞状细胞癌
淋巴结转移
淋巴引流
体层摄影术
X线计算机
Esophageal squamous cell carcinoma
Lymph node metastasis
Lymphatic drainage
Tomography
X-raycomputed
作者简介
通信作者：李睿,E-mail：ddtwg_nsmc@163.com
