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目的 :探讨多排螺旋CT诊断早期胃癌不同组织学分型和不同淋巴结分区的转移淋巴结大小的最佳阈值。方法:收集经手术病理证实的早期胃癌患者104例,根据胃癌的组织学类型分为分化型和未分化型;根据胃周淋巴结解剖位置分为胃小弯区和胃大弯区。回顾分析所有患者的术前多排螺旋CT图像,在横断位图像上测量所有可见淋巴结的长轴径和短轴径,用受试者工作特征(receiver operator characteristic,ROC)曲线评估多排螺旋CT图像淋巴结长轴径和短轴径在诊断早期胃癌淋巴结转移中的价值。结果:各组的ROC曲线均显示,所有短轴径的曲线下面积(area under curve,AUC)均大于长轴径的AUC。短轴径最佳阈值分别为,总体为5.95 mm,分化型为6.25 mm,未分化型为5.95 mm,小弯区为5.95 mm,大弯区为6.05 mm。按不同组织学分型和淋巴结解剖位置,采用不同阈值判断淋巴结转移的准确率均为82.7%。结论:不同淋巴结区域采用不同的诊断阈值可提高判断早期胃癌淋巴结转移的准确率。
Objective: To explore the optimal threshold value of multi-slice spiral CT in diagnosis of lymph node metastasis in different histological types and different lymph node sections of early gastric cancer. Methods: A total of 104 patients with early gastric cancer confirmed by pathology were divided into differentiated and undifferentiated cases according to the histological type of gastric cancer. According to the anatomical location of gastric lymph nodes, they were divided into gastric lesser curvature area and greater curvature area. The preoperative multislice spiral CT images of all patients were retrospectively analyzed. The long and short axis diameters of all visible lymph nodes were measured on the transverse image. The receiver operator characteristic (ROC) curve was used to evaluate the accuracy of multi-slice spiral CT The value of long axis and short axis of lymph nodes in the diagnosis of lymph node metastasis of early gastric cancer. Results: The ROC curves of each group showed that the area under curve (AUC) of all short axis diameters was larger than that of the long axis diameter. The best short axis diameters were 5.95 mm, 6.25 mm for differentiation, 5.95 mm for undifferentiated, 5.95 mm for small bend and 6.05 mm for large bend. According to different histological types and lymph node anatomical locations, the accuracy of different thresholds for determining lymph node metastasis was 82.7%. Conclusion: Different diagnostic thresholds can be used in different lymph node regions to improve the accuracy of determining lymph node metastasis in early gastric cancer.